Provider Demographics
NPI:1851316913
Name:COLPITT, DEBRA SUE (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:SUE
Last Name:COLPITT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10512 NORTH 110TH EAST AVENUE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-6638
Mailing Address - Country:US
Mailing Address - Phone:918-376-8900
Mailing Address - Fax:918-376-8987
Practice Address - Street 1:10512 NORTH 110TH EAST AVENUE
Practice Address - Street 2:SUITE 300
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-6638
Practice Address - Country:US
Practice Address - Phone:918-376-8900
Practice Address - Fax:918-376-8987
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14288207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100100040BMedicaid
C94788Medicare UPIN
248426703Medicare ID - Type Unspecified