Provider Demographics
NPI:1144232109
Name:SHIRLEY, DEBORAH ALINE (MD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ALINE
Last Name:SHIRLEY
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 1:5 PROFESSIONAL PLZ
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-1900
Mailing Address - Country:US
Mailing Address - Phone:662-323-0999
Mailing Address - Fax:662-324-0250
Practice Address - Street 1:5 PROFESSIONAL PLZ
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-1900
Practice Address - Country:US
Practice Address - Phone:662-323-0999
Practice Address - Fax:662-324-0250
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS13209208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00113620Medicaid
MS09015837OtherGROUP MEDICAID NUMBER
MS00113620Medicaid
MS09015837OtherGROUP MEDICAID NUMBER