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General NPI Number Information
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NPI Number | 1588855225
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Entity Type | Organization
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Legal Business Name | DEBORAH R. DISTEFANO M.D.P.C.
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Dates
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Enumeration Date | 08/07/2007
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Last Update Date | 10/03/2012
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Provider Practice Location Address
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Address Line | 1815 GUNBARREL RD
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City | CHATTANOOGA
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State | TN
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Zip | 37421-3130
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Country | US
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Telephone | 423-648-3937
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Fax | 423-648-2043
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Provider Business Mailing Address
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Address Line | 1815 GUNBARREL RD
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City | CHATTANOOGA
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State | TN
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Zip | 37421-3130
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Country | US
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Telephone | 423-648-3937
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Fax | 423-648-2043
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. BARBARA JEAN MESERVE
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Credential |
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Telephone | 423-648-3937
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | MD14067
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License Number State | TN
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