Individual
DR. WILLIAM LEONARD DEVAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1000 N ALLEN ST, ROBINSON, IL 62454-1114
(618) 546-1294
(618) 546-2665
Mailing address
1000 N ALLEN ST, ROBINSON, IL 62454-1114
(618) 546-1294
(618) 546-2665
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
0101043815
VA
207X00000X
Orthopaedic Surgery Physician
Primary
036145174
IL
207X00000X
Orthopaedic Surgery Physician
201301122
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1215909718
—
VA
01
—
178HJ
BCBSNC ID
NC
01
—
NCD013A
MEDICARE PTAN
NC
Enumeration date
02/07/2006
Last updated
09/11/2020
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