Provider Demographics
NPI:1538381322
Name:WOLCOTT, DEANE LEROY (MD)
Entity type:Individual
Prefix:DR
First Name:DEANE
Middle Name:LEROY
Last Name:WOLCOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8201 BEVERLY BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-4505
Mailing Address - Country:US
Mailing Address - Phone:323-966-3571
Mailing Address - Fax:323-966-3685
Practice Address - Street 1:8201 BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4505
Practice Address - Country:US
Practice Address - Phone:323-966-3571
Practice Address - Fax:323-966-3685
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG285382084P0015X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine