Provider Demographics
NPI:1669446282
Name:DEBORJA, JOSE A (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:A
Last Name:DEBORJA
Suffix:
Gender:M
Credentials:DPM
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 705
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-8912
Mailing Address - Country:US
Mailing Address - Phone:410-822-0991
Mailing Address - Fax:410-822-0577
Practice Address - Street 1:611 DUTCHMANS LN
Practice Address - Street 2:SUITE C
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601
Practice Address - Country:US
Practice Address - Phone:410-822-0991
Practice Address - Fax:410-822-0577
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2018-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01268213ES0131X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDU75143Medicare UPIN
789M369FMedicare PIN