Provider Demographics
NPI:1710977020
Name:EEZZUDUEMHOI, DEBORAH ROSE (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:ROSE
Last Name:EEZZUDUEMHOI
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 1:1323 S 27TH ST STE 400
Mailing Address - Street 2:
Mailing Address - City:NEDERLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77627-6257
Mailing Address - Country:US
Mailing Address - Phone:409-434-0463
Mailing Address - Fax:
Practice Address - Street 1:1323 S 27TH ST STE 400
Practice Address - Street 2:
Practice Address - City:NEDERLAND
Practice Address - State:TX
Practice Address - Zip Code:77627-6257
Practice Address - Country:US
Practice Address - Phone:409-434-0463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3289208000000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200000570AMedicaid
NM53074041Medicaid
TX148956903Medicaid
NM77591Medicaid
NM77591OtherPRESBYTERIAN COMMERCIAL
TX127848101OtherFIRSTCARE COMMERCIAL
TX87151ZOtherHMO BLUE
NME003OtherTRIWEST
TX148956904Medicaid
TX8G7981OtherBC/BS
TXG0122506OtherDPS
TX127848102Medicaid
TX127848102Medicaid
TX127848102Medicaid
OK200000570AMedicaid
TXBE3921512OtherDEA