Provider Demographics
NPI:1184627754
Name:PRICE, DEBRA (MD)
Entity type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:
Last Name:PRICE
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 1:9060 SW 73RD CT STE 502
Mailing Address - Street 2:
Mailing Address - City:PINECREST
Mailing Address - State:FL
Mailing Address - Zip Code:33156-2961
Mailing Address - Country:US
Mailing Address - Phone:305-670-1111
Mailing Address - Fax:305-670-1110
Practice Address - Street 1:9060 SW 73RD CT
Practice Address - Street 2:
Practice Address - City:PINECREST
Practice Address - State:FL
Practice Address - Zip Code:33156-2961
Practice Address - Country:US
Practice Address - Phone:305-670-1111
Practice Address - Fax:305-670-1110
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2020-11-04
Deactivation Date:2005-05-31
Deactivation Code:
Reactivation Date:2005-09-26
Provider Licenses
StateLicense IDTaxonomies
FLME039031207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258134500Medicaid
FLE34403Medicare UPIN
FL258134500Medicaid