Provider Demographics
NPI:1679754758
Name:GILMORE, DEBORAH BULLOCK (CFM,CFTS)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:BULLOCK
Last Name:GILMORE
Suffix:
Gender:F
Credentials:CFM,CFTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 N BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:ELKIN
Mailing Address - State:NC
Mailing Address - Zip Code:28621-3008
Mailing Address - Country:US
Mailing Address - Phone:336-835-3131
Mailing Address - Fax:336-835-2358
Practice Address - Street 1:817 N BRIDGE ST
Practice Address - Street 2:
Practice Address - City:ELKIN
Practice Address - State:NC
Practice Address - Zip Code:28621-3008
Practice Address - Country:US
Practice Address - Phone:336-835-3131
Practice Address - Fax:336-835-2358
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-17
Last Update Date:2007-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies