Provider Demographics
NPI:1215044862
Name:DUFOUR, DEBRA A (DPH)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:A
Last Name:DUFOUR
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10109 E 79TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-4564
Mailing Address - Country:US
Mailing Address - Phone:918-286-5369
Mailing Address - Fax:918-286-5243
Practice Address - Street 1:1017 W 120TH CT S
Practice Address - Street 2:
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037-2853
Practice Address - Country:US
Practice Address - Phone:918-298-3708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9506183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist