Provider Demographics
NPI:1801828009
Name:ST CLAIR, DEBORAH SUE (MD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:SUE
Last Name:ST CLAIR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:SMITH
Other - Last Name:ST CLAIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1100 BISHOP STREET
Mailing Address - Street 2:PO BOX 1026
Mailing Address - City:UNION CITY
Mailing Address - State:TN
Mailing Address - Zip Code:38261
Mailing Address - Country:US
Mailing Address - Phone:731-885-0111
Mailing Address - Fax:731-885-0112
Practice Address - Street 1:1100 BISHOP STREET
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261
Practice Address - Country:US
Practice Address - Phone:731-885-0111
Practice Address - Fax:731-885-0112
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD14012207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3194480Medicaid
3194480Medicare ID - Type Unspecified
TN3194480Medicaid