Provider Demographics
NPI:1043352776
Name:MA, DEBORA (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBORA
Middle Name:
Last Name:MA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2668 NORTHPARK DR STE 110
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-3365
Mailing Address - Country:US
Mailing Address - Phone:303-666-6336
Mailing Address - Fax:
Practice Address - Street 1:2668 NORTHPARK DR STE 110
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-3365
Practice Address - Country:US
Practice Address - Phone:303-666-6336
Practice Address - Fax:303-666-0616
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO40474208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
COH38854Medicare UPIN