Individual
ANTHONY WAYNE DEVERAUX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
664 SLATE AVENUE, OWINGSVILLE, KY 40360
(606) 674-6690
(606) 674-6903
Mailing address
PO BOX 790, ASHLAND, KY 41105-0790
(606) 329-8588
(606) 329-8195
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
0721
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000355703
ANTHEM BCBS
—
05
—
30610026
—
KY
Enumeration date
08/04/2006
Last updated
07/08/2007
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