Provider Demographics
NPI:1821077546
Name:DEROUIN, PAMELA LOUISE (MD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:LOUISE
Last Name:DEROUIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PAMELA
Other - Middle Name:LOUISE
Other - Last Name:PIGGOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2737 E ARIZONA BILTMORE CIR
Mailing Address - Street 2:#13
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-2169
Mailing Address - Country:US
Mailing Address - Phone:602-288-6782
Mailing Address - Fax:
Practice Address - Street 1:2737 E ARIZONA BILTMORE CIR
Practice Address - Street 2:#13
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-2169
Practice Address - Country:US
Practice Address - Phone:602-288-6782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27613207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine