Provider Demographics
NPI:1295857449
Name:LEVITT, DEBRA T (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:T
Last Name:LEVITT
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 1:2726 W JACLYN DR
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-9191
Mailing Address - Country:US
Mailing Address - Phone:928-380-3960
Mailing Address - Fax:928-674-7705
Practice Address - Street 1:OFF HWY 191 HOSPITAL ROAD
Practice Address - Street 2:
Practice Address - City:CHINLE
Practice Address - State:AZ
Practice Address - Zip Code:86503
Practice Address - Country:US
Practice Address - Phone:928-674-7001
Practice Address - Fax:928-674-7705
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038627E207P00000X
AZ36934207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ475633Medicaid
AZC34820Medicare UPIN
AZ8HZM85Medicare ID - Type UnspecifiedMEDICARE PART B - CHINLE
AZ8HZM92Medicare ID - Type UnspecifiedMEDICARE PART B - PINON
AZ8HZL76Medicare ID - Type UnspecifiedMEDICARE PART B - TSAILE