Provider Demographics
NPI:1851396139
Name:LUSK, DEBRA JANN (DPM)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:JANN
Last Name:LUSK
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:MRS
Other - First Name:DEBRA
Other - Middle Name:LUSK
Other - Last Name:WEINMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6260 DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-7602
Mailing Address - Country:US
Mailing Address - Phone:409-899-1538
Mailing Address - Fax:409-899-2120
Practice Address - Street 1:6260 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-7602
Practice Address - Country:US
Practice Address - Phone:409-899-1538
Practice Address - Fax:409-899-2120
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1347213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX041086202Medicaid
TXT90594Medicare UPIN
TX82961JMedicare ID - Type Unspecified