Provider Demographics
NPI:1063660819
Name:IRIZARRY, DEBRA ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:ANNE
Last Name:IRIZARRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 749
Mailing Address - Street 2:
Mailing Address - City:CRESTONE
Mailing Address - State:CO
Mailing Address - Zip Code:81131-0749
Mailing Address - Country:US
Mailing Address - Phone:719-256-6600
Mailing Address - Fax:719-256-5796
Practice Address - Street 1:46 CAMINO BACA GRANDE
Practice Address - Street 2:SUITE #102
Practice Address - City:CRESTONE
Practice Address - State:CO
Practice Address - Zip Code:81131
Practice Address - Country:US
Practice Address - Phone:719-256-6600
Practice Address - Fax:719-256-5796
Is Sole Proprietor?:No
Enumeration Date:2008-09-05
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1679111208200000X
NM9677208200000X
CO46205208200000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
72651OtherWORKERS COMP
F59113Medicare UPIN