Provider Demographics
NPI:1649371055
Name:METTER, DEBRA ANN (DO)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANN
Last Name:METTER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:ANN
Other - Last Name:MCCOMB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:659 S CENTRAL VALLEY HWY
Mailing Address - Street 2:
Mailing Address - City:SHAFTER
Mailing Address - State:CA
Mailing Address - Zip Code:93263-2790
Mailing Address - Country:US
Mailing Address - Phone:661-459-1900
Mailing Address - Fax:661-459-1974
Practice Address - Street 1:659 S CENTRAL VALLEY HWY
Practice Address - Street 2:
Practice Address - City:SHAFTER
Practice Address - State:CA
Practice Address - Zip Code:93263-2790
Practice Address - Country:US
Practice Address - Phone:661-459-1913
Practice Address - Fax:661-459-1974
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001378208000000X
CA20A11731208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1076454Medicaid
WAAB17220Medicare ID - Type Unspecified
WAF21370Medicare UPIN