Provider Demographics
NPI:1568680494
Name:SIRMANS, DEBBRA J (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBBRA
Middle Name:J
Last Name:SIRMANS
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 1:1380 BRIES WAY
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-6708
Mailing Address - Country:US
Mailing Address - Phone:480-510-6276
Mailing Address - Fax:
Practice Address - Street 1:1380 BRIES WAY
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6708
Practice Address - Country:US
Practice Address - Phone:480-510-6276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2011-0588208600000X
AZ27039208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNMAAA1577OtherMEDICARE PTAN
NM78573726Medicaid
AZ612839Medicaid
CO19676026Medicaid
AZ612839Medicaid
8HAK44Medicare PIN
320059Medicare Oscar/Certification