Basic Information
| Provider Information | |||||||||
| NPI: | 1508814179 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANDREWS | ||||||||
| FirstName: | DEBORA | ||||||||
| MiddleName: | THOMAS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 650 E INDIAN SCHOOL RD | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850121839 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022775551 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 650 E INDIAN SCHOOL RD | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850121839 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022775551 | ||||||||
| FaxNumber: | 6239749351 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2006 | ||||||||
| LastUpdateDate: | 07/05/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 23745 | AZ | Y | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | 070009056 | 01 | AZ | RAILROAD MEDICARE | OTHER | AZ0395880 | 01 | AZ | BLUE CROSS BLUE SHIELD | OTHER | 188961600 | 01 | AZ | DEPT OF LABOR WORK COMP | OTHER | 99S007000007 | 01 | AZ | MEDISUN | OTHER | 1508814179 | 01 | AZ | AHCCCS | OTHER | 347816 | 05 | AZ | MEDICAID | 1Z3680 | 01 | AZ | HEALTH NET | OTHER | 1800351 | 01 | AZ | UNITED HEALTHCARE | OTHER | 0812973 | 01 | AZ | AETNA | OTHER |