Healthcare Provider Details

I. General information

NPI: 1528122165
Provider Name (Legal Business Name): DEBORAH LYNN DEBAUCHE P.A.-C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6465 GREENWOOD PLAZA BLVD SUITE 300
GREENWOOD VILLAGE CO
80111-4905
US

IV. Provider business mailing address

12150 NORTHCLIFF RD
ELBERT CO
80106-8867
US

V. Phone/Fax

Practice location:
  • Phone: 888-795-7975
  • Fax:
Mailing address:
  • Phone: 719-495-0060
  • Fax: 719-494-2045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number592
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: