Provider Demographics
NPI:1003826272
Name:DEAL, JO P (MD)
Entity type:Individual
Prefix:
First Name:JO
Middle Name:P
Last Name:DEAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JO
Other - Middle Name:P
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6255 W SUNSET BLVD FL 21
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-7422
Mailing Address - Country:US
Mailing Address - Phone:323-860-5200
Mailing Address - Fax:323-467-7119
Practice Address - Street 1:766 LAKELAND DR # A
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4610
Practice Address - Country:US
Practice Address - Phone:601-368-3440
Practice Address - Fax:601-368-3441
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS10460207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSP01065367OtherRAILROAD MEDICARE
MS00018389Medicaid
MS302I449808Medicare PIN
MSP01065367OtherRAILROAD MEDICARE