Provider Demographics
NPI:1710192869
Name:GOLOB, DEBORAH SUE (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:SUE
Last Name:GOLOB
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 1:1603 116TH AVE NE
Mailing Address - Street 2:STE 112
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3009
Mailing Address - Country:US
Mailing Address - Phone:425-454-0526
Mailing Address - Fax:425-455-0076
Practice Address - Street 1:2281 116TH AVE NE
Practice Address - Street 2:STE 200
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3037
Practice Address - Country:US
Practice Address - Phone:425-454-0526
Practice Address - Fax:425-455-0076
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00044606207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT110006302Medicaid
CT110006302Medicare ID - Type Unspecified
CT110006302Medicaid