Provider Demographics
NPI:1841248168
Name:DEVAUL, CHANSON ALBERT (DO)
Entity type:Individual
Prefix:DR
First Name:CHANSON
Middle Name:ALBERT
Last Name:DEVAUL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1725 TARBORO ST SW
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-3428
Mailing Address - Country:US
Mailing Address - Phone:252-237-2891
Mailing Address - Fax:252-237-0115
Practice Address - Street 1:1725 TARBORO ST SW
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-3428
Practice Address - Country:US
Practice Address - Phone:252-237-2891
Practice Address - Fax:252-237-0115
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2015-10-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC9400464207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCF87896Medicare UPIN