Individual
DEON F FAILLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2041 VALLEYGATE DR, SUITE 202-A, FAYETTEVILLE, NC 28304
(910) 485-6277
Mailing address
PO BOX 61811, DURHAM, NC 27715-1811
(919) 544-6318
(919) 544-6336
Taxonomy
Speciality
Code
Description
License number
State
2083P0011X
Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
31809
NC
208600000X
Surgery Physician
Primary
31809
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
31041
BCBS-NC INDIVIDUAL
NC
05
—
7931041
—
NC
01
—
P00352202
MEDICARE-RAILROAD
NC
Enumeration date
04/28/2006
Last updated
07/31/2018
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