Provider Demographics
NPI:1265492458
Name:SIXTA, DEBRA ANN (MD)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANN
Last Name:SIXTA
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 1:2720 8TH ST SW
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:IA
Mailing Address - Zip Code:50009-1028
Mailing Address - Country:US
Mailing Address - Phone:515-967-0133
Mailing Address - Fax:515-967-7578
Practice Address - Street 1:2720 8TH ST SW
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:IA
Practice Address - Zip Code:50009-1028
Practice Address - Country:US
Practice Address - Phone:515-967-0133
Practice Address - Fax:515-967-7578
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA30036207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1265492458Medicaid
IA1129809Medicaid
IA719260410Medicare PIN
IA1129809Medicaid
54233Medicare ID - Type Unspecified