Provider Demographics
NPI:1639721772
Name:BRABHAM, DEBORAH (PHD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:BRABHAM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:BRABHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10990 LYDIA ESTATES DR E
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-6940
Mailing Address - Country:US
Mailing Address - Phone:904-891-8706
Mailing Address - Fax:
Practice Address - Street 1:10990 LYDIA ESTATES DR E
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-6940
Practice Address - Country:US
Practice Address - Phone:904-891-8706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN2057692208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice