Provider Demographics
NPI:1023155546
Name:DEVANE, JO LEE (MD)
Entity type:Individual
Prefix:DR
First Name:JO
Middle Name:LEE
Last Name:DEVANE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3011 CHESTNUT CIR NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-2110
Mailing Address - Country:US
Mailing Address - Phone:423-478-2417
Mailing Address - Fax:
Practice Address - Street 1:1120 N OCOEE ST
Practice Address - Street 2:LEE UNIVERSITY HEALTH CLINIC
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-4458
Practice Address - Country:US
Practice Address - Phone:423-614-8430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN012009208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3722363Medicaid
TN4012706OtherBLUE CROSS NUMBER
TN3722363Medicaid
TN3845234Medicare ID - Type UnspecifiedMEDICARE