Provider Demographics
NPI:1013042779
Name:ROMAN, DEBRA SHEINBACH (DO)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:SHEINBACH
Last Name:ROMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2429 W ELLIS AVE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-2330
Mailing Address - Country:US
Mailing Address - Phone:208-859-5055
Mailing Address - Fax:
Practice Address - Street 1:2429 W ELLIS AVE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-2330
Practice Address - Country:US
Practice Address - Phone:208-859-5055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDO327207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDB420936Medicare UPIN