Provider Demographics
NPI:1023050614
Name:DANIEL, DEBORA C (MD)
Entity type:Individual
Prefix:DR
First Name:DEBORA
Middle Name:C
Last Name:DANIEL
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 1389
Mailing Address - Street 2:
Mailing Address - City:DUNLAP
Mailing Address - State:TN
Mailing Address - Zip Code:37327-1389
Mailing Address - Country:US
Mailing Address - Phone:423-949-6300
Mailing Address - Fax:423-949-6374
Practice Address - Street 1:PO BOX 1389
Practice Address - Street 2:15166 RANKIN AVE
Practice Address - City:DUNLAP
Practice Address - State:TN
Practice Address - Zip Code:37327
Practice Address - Country:US
Practice Address - Phone:423-949-6300
Practice Address - Fax:423-949-6374
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-11
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000026084207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3376890Medicaid
TN3376890Medicaid
TN3056018Medicare ID - Type Unspecified