Individual
KENNETH DEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
301 WALNUT ST, AMITE, LA 70422-2025
(985) 748-9485
Mailing address
9333 IMPERIAL HWY, DOWNEY, CA 90242-2812
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
320128
LA
208M00000X
Hospitalist Physician
Primary
167908
CA
Other
Enumeration date
03/26/2016
Last updated
11/29/2021
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