Provider Demographics
NPI:1891742094
Name:WILSON, DEBORAH DYNE (PHYSICIAN)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:DYNE
Last Name:WILSON
Suffix:
Gender:F
Credentials:PHYSICIAN
Other - Prefix:DR
Other - First Name:DEBORAH
Other - Middle Name:D
Other - Last Name:NEMIRO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10250 N 92ND ST STE 102
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4517
Mailing Address - Country:US
Mailing Address - Phone:480-860-4791
Mailing Address - Fax:480-860-6314
Practice Address - Street 1:10250 N 92ND ST STE 102
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4517
Practice Address - Country:US
Practice Address - Phone:480-860-4791
Practice Address - Fax:480-860-6314
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMD26168207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D00030Medicare UPIN