Provider Demographics
NPI:1659434793
Name:SCHENCK, DEBORAH (MD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:SCHENCK
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 1:2420 W PIERCE ST
Mailing Address - Street 2:SUITE 200-B
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-3543
Mailing Address - Country:US
Mailing Address - Phone:575-628-0926
Mailing Address - Fax:575-628-0493
Practice Address - Street 1:2420 W PIERCE ST
Practice Address - Street 2:SUITE 103
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-3543
Practice Address - Country:US
Practice Address - Phone:505-887-8764
Practice Address - Fax:505-887-8779
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM981542083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E95915Medicare UPIN