Alan E Deddens, M.D.

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

9400465 Issued in NC

Practice address

707 Bryant St
Statesville, NC 28677-4142

Phone

(704) 873-5224

NPI assigned

Aug 19, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1124409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1201132800000",
    "number": "1366434870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "650 SIGNAL HILL DRIVE EXT",
            "address_2": "PO BOX 1845",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286254353",
            "telephone_number": "704-873-4277",
            "fax_number": "704-873-4511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "707 BRYANT ST",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286774142",
            "telephone_number": "704-873-5224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEDDENS",
        "first_name": "ALAN",
        "middle_name": "E",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-19",
        "last_updated": "2008-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "NC",
            "license": "9400465",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8928084",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Otolaryngology Physician in Statesville, NC
• Providers in Statesville, NC by specialty
• Otolaryngology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.