Provider Demographics
NPI:1710966239
Name:BALDEMOR, DEBORAH L (MD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:L
Last Name:BALDEMOR
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 1:7558 W THUNDERBIRD RD
Mailing Address - Street 2:SUITE 1-496
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-6080
Mailing Address - Country:US
Mailing Address - Phone:623-977-2707
Mailing Address - Fax:
Practice Address - Street 1:13090 N 94TH DR
Practice Address - Street 2:SUITE 101
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4256
Practice Address - Country:US
Practice Address - Phone:623-977-2707
Practice Address - Fax:623-977-2331
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26429207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZG69627Medicare UPIN
AZ437378Medicare ID - Type Unspecified
AZ23986Medicare ID - Type Unspecified