Provider Demographics
NPI:1407986912
Name:DEUBLER, DEBORAH EILEEN (PA-C)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:EILEEN
Last Name:DEUBLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10726 ROYAL RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-8007
Mailing Address - Country:US
Mailing Address - Phone:225-266-6894
Mailing Address - Fax:985-785-7753
Practice Address - Street 1:1057 PAUL MAILLARD RD
Practice Address - Street 2:SUITE D-1900
Practice Address - City:LULING
Practice Address - State:LA
Practice Address - Zip Code:70070-4349
Practice Address - Country:US
Practice Address - Phone:985-785-5636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA.A10572.RX363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2393154Medicaid
MS07403824Medicaid
MS07403824Medicaid