Provider Demographics
NPI:1811167695
Name:DEEVERS, HOWARD ARNOLD
Entity type:Individual
Prefix:
First Name:HOWARD
Middle Name:ARNOLD
Last Name:DEEVERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6402 N VIA PICCOLINA
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-3111
Mailing Address - Country:US
Mailing Address - Phone:520-877-3201
Mailing Address - Fax:
Practice Address - Street 1:6402 N VIA PICCOLINA
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-3111
Practice Address - Country:US
Practice Address - Phone:520-877-3201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10190808Q332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ3983640001Medicare NSC