Southeastern Surgery

NPI #1639536089 in Logan, Ohio

Provider Information

NPI Number: 1639536089
Entity Type: Organization
Organization Name: Southeastern Surgery
Primary Specialty: Clinic/Center
Enumeration Date: Jan 15, 2016
Last Updated: Jan 15, 2016

Practice Location

Address: 144 EAST MAIN STREET
City: Logan
State: Ohio
ZIP Code: 43138
Phone: (740) 385-1881

Authorized Official

Name: DR. JOHN DUFFY DEWALT, DO
Title: SURGEON
Phone: (740) 385-1881

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center	261Q00000X	Primary

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