Healthcare Provider Details

I. General information

NPI: 1740288463
Provider Name (Legal Business Name): DEBRA J. DEBIASSE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 12/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

737 E CRAWFORD ST
SALINA KS
67401-5103
US

IV. Provider business mailing address

737 E CRAWFORD ST
SALINA KS
67401-5103
US

V. Phone/Fax

Practice location:
  • Phone: 785-827-7261
  • Fax: 785-827-6334
Mailing address:
  • Phone: 785-827-7261
  • Fax: 785-827-6334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number04/23338
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: