Provider Demographics
NPI:1518900224
Name:PRICE, DEBORAH D (DO)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:D
Last Name:PRICE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 843225
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-3225
Mailing Address - Country:US
Mailing Address - Phone:708-633-1234
Mailing Address - Fax:708-342-7100
Practice Address - Street 1:3250 GORDONVILLE RD
Practice Address - Street 2:SUITE 301
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5056
Practice Address - Country:US
Practice Address - Phone:573-334-9641
Practice Address - Fax:573-331-3120
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2010-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODOR3P08207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1518900224Medicaid
IL1518900224Medicaid
MO182652OtherHEALTHLINK
MO603531OtherANTHEM BCBS
MOP00779926OtherRR MCR
MO1518900224Medicaid
MO035010653Medicare PIN