Provider Demographics
NPI:1013998152
Name:MCDERMOTT, DEBORAH K (MD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:K
Last Name:MCDERMOTT
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:PO BOX 23340
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63156-3340
Mailing Address - Country:US
Mailing Address - Phone:618-277-7500
Mailing Address - Fax:618-277-4236
Practice Address - Street 1:4 PARK PL
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-2965
Practice Address - Country:US
Practice Address - Phone:618-277-7500
Practice Address - Fax:618-277-4236
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-061906207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036061906Medicaid
IL0407153OtherUHC
IL000000010025OtherESSENCE
IL122607OtherHEALTHLINK
IL2788OtherBCBS TRI ST
IL4545931822Medicaid
IL08221955OtherBCBS
IL127467OtherGHP
IL4227190OtherAETNA
ILC45318OtherMERCY
IL110210895Medicare PIN
IL122607OtherHEALTHLINK
IL036061906Medicaid