Individual
WAYNE R DEVANTIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3235 ACADEMY AVE, SUITE 200, PORTSMOUTH, VA 23703-3200
(757) 483-0400
Mailing address
3235 ACADEMY AVE STE 200, PORTSMOUTH, VA 23703-3200
(757) 410-3435
(757) 548-9563
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
0101040502
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
325051
ANTHEM
VA
05
—
6306403
—
VA
Enumeration date
08/08/2006
Last updated
05/19/2021
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