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General NPI Number Information
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NPI Number | 1104800515
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Entity Type | Individual
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Provider Name | COLLEEN M DEBARR DPM
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Gender | Female
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Dates
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Enumeration Date | 11/30/2005
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Last Update Date | 07/31/2012
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Provider Practice Location Address
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Address Line | 5172 LEAVITT RD
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City | LORAIN
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State | OH
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Zip | 44035
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Country | US
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Telephone | 440-282-7420
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Fax | 440-282-9855
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Provider Business Mailing Address
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Address Line | 5334 MEADOW LANE COURT
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City | SHEFFIELD VILLAGE
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State | OH
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Zip | 44035-1469
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Country | US
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Telephone | 440-934-5454
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Fax | 440-934-8979
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 000629
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 36.003563
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License Number State | OH
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