Healthcare Provider Details

I. General information

NPI: 1184627754
Provider Name (Legal Business Name): DEBRA PRICE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 11/04/2020
Certification Date: 11/04/2020
Deactivation Date: 05/31/2005
Reactivation Date: 09/26/2005

III. Provider practice location address

9060 SW 73RD CT
PINECREST FL
33156-2961
US

IV. Provider business mailing address

9060 SW 73RD CT STE 502
PINECREST FL
33156-2961
US

V. Phone/Fax

Practice location:
  • Phone: 305-670-1111
  • Fax: 305-670-1110
Mailing address:
  • Phone: 305-670-1111
  • Fax: 305-670-1110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME039031
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: