Provider Demographics
NPI:1942637103
Name:LOCKE, DEBORAH RENEE (PA)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:RENEE
Last Name:LOCKE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2084 E 67TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-6008
Mailing Address - Country:US
Mailing Address - Phone:187-444-8014
Mailing Address - Fax:184-448-0687
Practice Address - Street 1:2055 W HOSPITAL DR
Practice Address - Street 2:SUITE 205
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704
Practice Address - Country:US
Practice Address - Phone:520-792-2199
Practice Address - Fax:520-818-9992
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY016897-1363AM0700X
363AM0700X
AZ5493363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical