MEDICARE: DEBORAH M MIDDLETON

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
1	104100000X	Social Worker	002265	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578621009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH M MIDDLETON

Provider Business Mailing Address
First Line	:	1424 BOYD LN
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65202-2813
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3405 W. TRUMAN, 101
Second Line	:
City	:	JEFFERSON CITY
State	:	MO
Zip	:	65109-5861
Country	:	US
Telephone Number	:	573-864-7868
Fax Number	:	573-864-7868

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	12/21/2010

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Directions to “ DEBORAH M MIDDLETON ” Practice Location

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