Provider Demographics
NPI:1215909718
Name:DEVAULT, WILLIAM LEONARD (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:LEONARD
Last Name:DEVAULT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 N ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:ROBINSON
Mailing Address - State:IL
Mailing Address - Zip Code:62454-1114
Mailing Address - Country:US
Mailing Address - Phone:618-546-1294
Mailing Address - Fax:618-546-2665
Practice Address - Street 1:1000 N ALLEN ST
Practice Address - Street 2:
Practice Address - City:ROBINSON
Practice Address - State:IL
Practice Address - Zip Code:62454-1114
Practice Address - Country:US
Practice Address - Phone:618-546-1294
Practice Address - Fax:618-546-2665
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201301122207X00000X
VA0101043815207X00000X
IL036145174207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC178HJOtherBCBSNC ID
NCNCD013AOtherMEDICARE PTAN
VA1215909718Medicaid
NC178HJOtherBCBSNC ID