Provider Demographics
NPI:1578370409
Name:DEA, MD, PC
Entity type:Organization
Organization Name:DEA, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DERRON
Authorized Official - Middle Name:E
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-479-0743
Mailing Address - Street 1:PO BOX 3350
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38557-3350
Mailing Address - Country:US
Mailing Address - Phone:931-248-1414
Mailing Address - Fax:931-707-5178
Practice Address - Street 1:138 FAIRBANKS RD
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-7077
Practice Address - Country:US
Practice Address - Phone:931-248-1414
Practice Address - Fax:931-707-5178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-13
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty