Provider Demographics
NPI:1952380180
Name:MASSEY-EYRE, DEBORAH A (MD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:A
Last Name:MASSEY-EYRE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:A
Other - Last Name:MASSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6002 BROWNSBORO PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-1298
Mailing Address - Country:US
Mailing Address - Phone:502-897-3232
Mailing Address - Fax:
Practice Address - Street 1:6002 BROWNSBORO PARK BLVD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-1298
Practice Address - Country:US
Practice Address - Phone:502-897-3232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY36049208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64091051Medicaid
KY50005698OtherPASSPORT
KY50005698OtherPASSPORT