Provider Demographics
NPI:1891713616
Name:WARDLY, DEBORAH ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:ELIZABETH
Last Name:WARDLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2921 ZELDA RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-2682
Mailing Address - Country:US
Mailing Address - Phone:334-277-5431
Mailing Address - Fax:
Practice Address - Street 1:2921 ZELDA RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-2682
Practice Address - Country:US
Practice Address - Phone:334-277-5431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9074935208000000X
AL00027464208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
F79699Medicare UPIN