Provider Demographics
NPI:1710970173
Name:DRALUCK, DEBRA (MD)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:DRALUCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2496 RICKER ROAD
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79920
Mailing Address - Country:US
Mailing Address - Phone:915-742-6007
Mailing Address - Fax:915-742-2363
Practice Address - Street 1:271 PASEO DE DIA STE 1A
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-7341
Practice Address - Country:US
Practice Address - Phone:575-323-6500
Practice Address - Fax:575-323-6501
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2001-176207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM79978011Medicaid
NM343409701Medicare ID - Type Unspecified
NM79978011Medicaid