Basic Information
| Provider Information | |||||||||
| NPI: | 1750604542 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | BLANK | ||||||||
| FirstName: | DEBBY | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1951 N WILMOT RD | ||||||||
| Address2: | BLDG. #1 STE.# 2 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857128000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5207223777 | ||||||||
| FaxNumber: | 5202966224 | ||||||||
| Practice Location | |||||||||
| Address1: | 5981 E GRANT RD | ||||||||
| Address2: | STE. #115 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857122363 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5208865315 | ||||||||
| FaxNumber: | 5202988204 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2010 | ||||||||
| LastUpdateDate: | 03/08/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 42490 | AZ | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.