Provider Demographics
NPI:1508814179
Name:ANDREWS, DEBORA THOMAS (MD)
Entity type:Individual
Prefix:
First Name:DEBORA
Middle Name:THOMAS
Last Name:ANDREWS
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 1:1490 N TURQUOISE DR
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-1383
Mailing Address - Country:US
Mailing Address - Phone:928-774-5074
Mailing Address - Fax:928-779-0884
Practice Address - Street 1:450 S WILLARD ST STE 115
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-6744
Practice Address - Country:US
Practice Address - Phone:928-639-9596
Practice Address - Fax:928-639-0189
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23745207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1Z3680OtherHEALTH NET
AZ0812973OtherAETNA
AZ188961600OtherDEPT OF LABOR WORK COMP
AZ347816Medicaid
AZAZ0395880OtherBLUE CROSS BLUE SHIELD
AZ070009056OtherRAILROAD MEDICARE
AZ99S007000007OtherMEDISUN
AZ1800351OtherUNITED HEALTHCARE
AZ0812973OtherAETNA
AZ0812973OtherAETNA
AZ347816Medicaid
WCHTR06Medicare ID - Type Unspecified