Provider Demographics
NPI:1659318368
Name:PRIOR, DEBORAH L (MD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:L
Last Name:PRIOR
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 1:407 S MAIN ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:VIROQUA
Mailing Address - State:WI
Mailing Address - Zip Code:54665-2057
Mailing Address - Country:US
Mailing Address - Phone:608-637-4230
Mailing Address - Fax:608-637-4214
Practice Address - Street 1:407 S MAIN ST
Practice Address - Street 2:SUITE 400
Practice Address - City:VIROQUA
Practice Address - State:WI
Practice Address - Zip Code:54665-2057
Practice Address - Country:US
Practice Address - Phone:608-637-4230
Practice Address - Fax:608-637-4214
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI37254208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIG17583Medicare UPIN