Provider Demographics
NPI:1386628709
Name:ST. CLAIR, DEBORAH C (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:C
Last Name:ST. CLAIR
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 1:1315 S HOWARD AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-3193
Mailing Address - Country:US
Mailing Address - Phone:813-350-9090
Mailing Address - Fax:813-443-5783
Practice Address - Street 1:1315 S HOWARD AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3193
Practice Address - Country:US
Practice Address - Phone:813-350-9090
Practice Address - Fax:813-443-5783
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA056040207Q00000X
FLME123410207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP264Medicare PIN
GA08CBBGDMedicare PIN
GAI47744Medicare UPIN
FLID415ZMedicare PIN