Provider Information for 1841543147
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Mr. GEORGE WILLIAM DEEGAN PSW874
Sex: Male
NPI: 1841543147
Last Updated: 2012-10-24
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||||||||||
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| NPI | 1841543147 | ||||||||||||||||||||
| Enumeration Date | 2012-10-24 | ||||||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||||||
| Sole Proprietor | NO | ||||||||||||||||||||
| Status | Active | ||||||||||||||||||||
| Mailing Address | 306 UNION AVE CRESCENT CITY, FL 32112-4432 United States Phone: 386-698-1232 | Fax:386-698-4154 | ||||||||||||||||||||
| Primary Practice Address | 306 UNION AVE CRESCENT CITY, FL 32112-4432 United States Phone: 386-698-1232 | Fax:386-698-4154 | ||||||||||||||||||||
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