Doctor Name: | MR. GEORGE JOSEPH DEVITA |
NPI Number: | 1104803964 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PA-C |
License Number: | |
Business Practice Address: | 11050 Mount Belvedere Blvd Usa Meddac Attn: Credentials Fort Drum, NY - 136025438 |
Business Phone Number: | 3157724025 |
Business Fax Number: | 3157729498 |
Mailing Address: | 27082 Waddingham Rd, EVANS MILLS |
State: | NY |
Postal Code: | 136373277 |
Phone Number: | 3157723225 |
Fax Number: | |
NPI Enumeration Date: | 12/22/2005 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |