Individual
TIMOTHY J DEVRIES
Active
Individual
TIMOTHY J DEVRIES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
211
MT
363AS0400X
Surgical Physician Assistant
622
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
434282
—
MT
Enumeration date
10/28/2005
Last updated
11/27/2023
Update your record
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