Provider Demographics
NPI:1508814179
Name:ANDREWS, DEBORA THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:DEBORA
Middle Name:THOMAS
Last Name:ANDREWS
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 1:650 E INDIAN SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1839
Mailing Address - Country:US
Mailing Address - Phone:602-277-5551
Mailing Address - Fax:
Practice Address - Street 1:650 E INDIAN SCHOOL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1839
Practice Address - Country:US
Practice Address - Phone:602-277-5551
Practice Address - Fax:623-974-9351
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23745207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ070009056OtherRAILROAD MEDICARE
AZAZ0395880OtherBLUE CROSS BLUE SHIELD
AZ188961600OtherDEPT OF LABOR WORK COMP
AZ99S007000007OtherMEDISUN
AZ1508814179OtherAHCCCS
AZ347816Medicaid
AZ1Z3680OtherHEALTH NET
AZ1800351OtherUNITED HEALTHCARE
AZ0812973OtherAETNA
AZ0812973OtherAETNA
AZ347816Medicaid
WCHTR06Medicare ID - Type Unspecified