Provider Demographics
NPI:1760670889
Name:DEUKMEDJIAN, ARMEN ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:ARMEN
Middle Name:ROBERT
Last Name:DEUKMEDJIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2653 BRUCE B DOWNS BLVD # 108168
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-9206
Mailing Address - Country:US
Mailing Address - Phone:813-997-2099
Mailing Address - Fax:813-280-6193
Practice Address - Street 1:2590 HEALING WAY STE 310
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33543-5497
Practice Address - Country:US
Practice Address - Phone:813-333-1186
Practice Address - Fax:844-691-5928
Is Sole Proprietor?:No
Enumeration Date:2007-10-15
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME110299207T00000X
FLTRN11121390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012447600Medicaid
FL14V46OtherBLUE CROSS BLUE SHIELD
FLHV916ZMedicare PIN