Provider Demographics
NPI:1700473048
Name:DEBRILL, CLIFFORD RAYMOND I (CERTIFIED PROVIDER)
Entity Type:Individual
Prefix:MR
First Name:CLIFFORD
Middle Name:RAYMOND
Last Name:DEBRILL
Suffix:I
Gender:M
Credentials:CERTIFIED PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 MARLAY RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-1949
Mailing Address - Country:US
Mailing Address - Phone:937-723-8209
Mailing Address - Fax:937-979-4298
Practice Address - Street 1:500 MARLAY RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-1949
Practice Address - Country:US
Practice Address - Phone:937-723-8209
Practice Address - Fax:937-979-4298
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider