Provider Demographics
NPI:1770672586
Name:VALIS, DEBRA A (MD)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:A
Last Name:VALIS
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:PO BOX 99406
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76199-0406
Mailing Address - Country:US
Mailing Address - Phone:817-605-2833
Mailing Address - Fax:
Practice Address - Street 1:6316 PRECINCT LINE RD
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-2766
Practice Address - Country:US
Practice Address - Phone:817-605-2500
Practice Address - Fax:817-605-2983
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2867208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0050NCOtherBCBSTX GRP PIN
1912978891OtherGRP NPI NUMBER
TX10028901OtherAMERIGROUP PIN
TX170994101Medicaid
TX137544613Medicaid
TX8B7944OtherBCBSTX IND PIN
TX8V0286OtherBCBS
TX125966102OtherFIRSTCARE PIN
TX163314101Medicaid
TX080626701Medicaid
TX137544611Medicaid
TX137544612Medicaid
TX4140263OtherAETN APIN
TX101503OtherSUPERIOR PIN
TX54148OtherFIRSTHEALTH PIN
TX137544613Medicaid