Provider Demographics
NPI:1437135613
Name:ARCHER, DEBORAH (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:
Last Name:ARCHER
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 1:2220 FOSSIL CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-7109
Mailing Address - Country:US
Mailing Address - Phone:401-225-9879
Mailing Address - Fax:
Practice Address - Street 1:1001 E HARMONY RD # 117
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-8891
Practice Address - Country:US
Practice Address - Phone:401-225-9879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0043443208000000X
CO434432080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO19634757Medicaid
CO19634757Medicaid