Provider Demographics
NPI:1336181981
Name:DEATON, WILLIAM J (DO)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:DEATON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13872 128TH AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-9775
Mailing Address - Country:US
Mailing Address - Phone:616-856-1264
Mailing Address - Fax:
Practice Address - Street 1:13872 128TH AVE
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-9775
Practice Address - Country:US
Practice Address - Phone:616-856-1264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015965207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4878730Medicaid
MI4878650Medicaid
MI4878749Medicaid
MI0154111485OtherBCBS
MI4878678Medicaid
MI1598712390OtherGROUP NPI
MI4878758Medicaid
MI381360529OtherTAX ID
MI4878749Medicaid