Individual
DR. GARY DEAVER BOSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4212 N 16TH ST, PHOENIX, AZ 85016-5319
(602) 263-1200
(602) 200-5383
Mailing address
PO BOX 31001-0698, PASADENA, CA 91110-0698
(602) 263-1200
(602) 200-5383
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
0418345
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100083430A
—
KS
05
—
201305919
—
MO
Enumeration date
06/01/2005
Last updated
10/21/2015
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