Provider Demographics
NPI:1821028903
Name:HACKETT, DEBORAH ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:ANTHONY
Last Name:HACKETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:A
Other - Last Name:HACKETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 27128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0128
Mailing Address - Country:US
Mailing Address - Phone:801-387-7900
Mailing Address - Fax:801-387-7910
Practice Address - Street 1:4403 HARRISON BLVD
Practice Address - Street 2:STE 3630
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-3271
Practice Address - Country:US
Practice Address - Phone:801-387-7900
Practice Address - Fax:801-387-7910
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT56313701205207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000063286Medicare PIN
005566705Medicare PIN
I06640Medicare UPIN