Provider Demographics
NPI:1841271889
Name:MCCARL, DEBRA L (MD)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:L
Last Name:MCCARL
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 1:1900 CENTRACARE CIR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-5000
Mailing Address - Country:US
Mailing Address - Phone:320-654-3630
Mailing Address - Fax:320-654-3657
Practice Address - Street 1:1900 CENTRACARE CIR
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-5000
Practice Address - Country:US
Practice Address - Phone:320-654-3630
Practice Address - Fax:320-654-3657
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN28181207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
69D59MCOtherBLUE CROSS BLUE SHIELD
111994OtherUCARE
0712564OtherMEDICA HEALTH PLANS
2116629OtherFIRST HEALTH PLAN
851495OtherARAZ GROUP AMERICAS PPO
990002OtherPREFERRED ONE
991068900OtherMEDICAL ASSISTANCE
HP23208OtherHEALTH PARTNERS
69D59MCOtherBLUE CROSS BLUE SHIELD
991068900OtherMEDICAL ASSISTANCE
160053129Medicare ID - Type UnspecifiedRR MEDICARE
990002OtherPREFERRED ONE