| Name: | W. C. Deavor, M.D., P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Dissolved |
| Date of registration: | 03 Jan 1989 (36 years ago) (Companies founded in January 1989) |
| Date of dissolution: | 06 Dec 2019 |
| Entity Number: | 000-128-181 |
| Register Number: | 000128181 |
| ZIP code: | 36702 (Companies in Dallas, 36702) |
| County: | Dallas |
| Place of Formation: | Dallas County |
| Principal Address: | SELMA, AL |
| Registered Office Street Address: | 203 VAUGHN MEMORIAL DRSELMA, AL 36702 |
| Authorized Capital: | $1,000 |
Activities
MEDICAL
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1972550531 | 2006-05-28 | 2020-08-22 | PO BOX 1470, SELMA, AL, 367021470, US | 203 VAUGHAN MEMORIAL DR, SELMA, AL, 367016950, US | |||||||||||||||||||||||||
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| Phone | +1 334-875-2134 |
| Fax | 3348754331 |
Authorized person
| Name | WILLIAM DEAVOR |
| Role | PHYSICIAN |
| Phone | 3348752134 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| License Number | 00003867 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 01697 |
| State | AL |
| Name | Role |
|---|---|
| DEAVOR, W C | Agent |
| Name | Role |
|---|---|
| DEAVOR, W C MD | Incorporator |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
