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General NPI Number Information
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NPI Number | 1356663413
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Entity Type | Organization
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Legal Business Name | WILLARD P DEBRABER DO PC
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Dates
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Enumeration Date | 02/17/2010
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Last Update Date | 05/18/2015
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Provider Practice Location Address
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Address Line | 1761 WELLS AVE
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City | MUSKEGON
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State | MI
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Zip | 49442-2459
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Country | US
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Telephone | 231-773-3228
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Fax | 231-773-3482
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Provider Business Mailing Address
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Address Line | 1761 WELLS AVE
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City | MUSKEGON
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State | MI
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Zip | 49442-2459
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Country | US
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Telephone | 231-773-3228
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Fax | 231-773-3482
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WILLARD PETER DEBRABER
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Credential | D.O.
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Telephone | 231-773-3228
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 5101006662
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License Number State | MI
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