Provider Demographics
NPI:1083667554
Name:WESTERGAARD, DEBORAH M (MDPA)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:M
Last Name:WESTERGAARD
Suffix:
Gender:F
Credentials:MDPA
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:M
Other - Last Name:WESTERGAARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MDPA
Mailing Address - Street 1:P.O. BOX 918005
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-8005
Mailing Address - Country:US
Mailing Address - Phone:214-750-6200
Mailing Address - Fax:214-750-6203
Practice Address - Street 1:9301 N. CENTRAL EXPRESSWAY
Practice Address - Street 2:SUITE 115
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-0806
Practice Address - Country:US
Practice Address - Phone:214-750-6200
Practice Address - Fax:214-750-6203
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3539174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD95826Medicare UPIN
TX00144QMedicare ID - Type Unspecified