Provider Demographics
NPI:1396830600
Name:DEBECK, THOMAS WADE (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:WADE
Last Name:DEBECK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2280 HEMBY LN
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-3773
Mailing Address - Country:US
Mailing Address - Phone:252-752-4848
Mailing Address - Fax:252-752-9607
Practice Address - Street 1:2280 HEMBY LN
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-3773
Practice Address - Country:US
Practice Address - Phone:252-752-4848
Practice Address - Fax:252-752-9607
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC235062084N0400X, 2084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Not Answered2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8928072Medicaid
NC28072OtherBCBS
NC22884OtherMEDCOST
NC28072OtherBCBS
NCC47633Medicare UPIN