Provider Demographics
NPI:1164410353
Name:SHEEHAN, DEBORAH LOU (DO)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:LOU
Last Name:SHEEHAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:LOU
Other - Last Name:WINTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1202 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILLOW SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:65793-3588
Mailing Address - Country:US
Mailing Address - Phone:417-469-1820
Mailing Address - Fax:
Practice Address - Street 1:1202 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLOW SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:65793-3588
Practice Address - Country:US
Practice Address - Phone:417-469-1820
Practice Address - Fax:417-469-5280
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3619207Q00000X
MO2009010253207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1164410353Medicaid
OK500522075OtherMEDICARE GROUP PIN
MOP00724816OtherRAILROAD MEDICARE
OK100131490BMedicaid
AR177582003Medicaid
431560263OtherTRICARE WEST
OKG80966Medicare UPIN
MO132300049Medicare PIN
OK4477801601Medicare PIN