Dr. Anthony V Deceanne
Foot & Ankle Surgery
5017 N Glen Park Place Rd
Peoria
, Illinois 61614-4677
Dr. Anthony V Deceanne
Foot & Ankle Surgery
5017 N Glen Park Place Rd
Peoria
, Illinois 61614-4677
(309) 689-8859
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About
Features
Specialties
- Foot & Ankle Surgery
Languages spoken
- English
Location
First Address
- Dr. Anthony V Deceanne
- 435 W Detweiller Dr
- Peoria, IL
- Zip : 61615-2116
- Phone : (309) 689-8859
Second Address
- Dr. Anthony V Deceanne
- 5017 N Glen Park Place Rd
- Peoria, IL
- Zip : 61614-4677
- Fax : (309) 692-2032
- Phone : (309) 691-1589
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 213ES0103X | Foot & Ankle Surgery | 016004489 | IL |
National Provider Identifier
| NPI | 1083613293 |
|---|---|
| Provider Name | Dr. Anthony V Deceanne |
| First Address | Peoria, IL 61615-2116 |
| Second Address | Peoria, IL 61614-4677 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 19/07/2005 |
| Last Update Date | 29/03/2010 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 016004489 | (05) | IL |
| L18879 | (02) | ID |
| L37909 | (02) | IL |
| U26359 | (02) | IL |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.