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NPI Code Detail

MEDICARE: DR. DEBORAH LOU SHEEHAN DO

MEDICARE: DR. DEBORAH LOU SHEEHAN DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician3619OK
2207Q00000XFamily Medicine Physician2009010253MO

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2500522075OTHEROKMEDICARE GROUP PIN
3P00724816OTHERMORAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6431560263OTHERTRICARE WEST

General Provider Information

NPI Number : 1164410353
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DEBORAH LOU SHEEHAN DO
Provider Business Mailing Address
First Line : 1202 E MAIN ST
Second Line :
City : WILLOW SPRINGS
State : MO
Zip : 65793-3588
Country : US
Telephone Number : 417-469-1820
Fax Number :
Provider Business Practice Location Address
First Line : 1202 E MAIN ST
Second Line :
City : WILLOW SPRINGS
State : MO
Zip : 65793-3588
Country : US
Telephone Number : 417-469-1820
Fax Number : 417-469-5280
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/11/2005
Last Update Date : 07/29/2019

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