Individual
GLENN ACORD DEYO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4521 82ND AVENUE CT W, UNIVERSITY PLACE, WA 98466-2325
(253) 312-8336
(253) 475-1185
Mailing address
4521 82ND AVENUE CT W, UNIVERSITY PLACE, WA 98466-2325
(253) 312-8336
(253) 475-1185
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
MD00026258
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0054140
L & I
WA
05
—
1054279
—
WA
05
—
7030539
—
WA
01
—
DE2889
REGENCE BLUE SHIELD
WA
Enumeration date
08/30/2006
Last updated
08/05/2011
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