Provider Demographics
NPI:1699828285
Name:ROUGEAU, DEBRA JONES (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:JONES
Last Name:ROUGEAU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2684 SANDICREST DR
Mailing Address - Street 2:
Mailing Address - City:CANTONMENT
Mailing Address - State:FL
Mailing Address - Zip Code:32533-7659
Mailing Address - Country:US
Mailing Address - Phone:850-477-6711
Mailing Address - Fax:
Practice Address - Street 1:250 BRENT LANE
Practice Address - Street 2:PENSACOLA CHRISTIAN COLLEGE, GRAF CLINIC
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503
Practice Address - Country:US
Practice Address - Phone:850-969-1636
Practice Address - Fax:850-969-1616
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0059740207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE99290Medicare UPIN