Provider Demographics
NPI:1982920039
Name:DEBORAH S QUADE MD PA
Entity Type:Organization
Organization Name:DEBORAH S QUADE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:S
Authorized Official - Last Name:QUADE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-316-5010
Mailing Address - Street 1:2519 MILITARY RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015-2498
Mailing Address - Country:US
Mailing Address - Phone:501-316-5010
Mailing Address - Fax:501-316-5014
Practice Address - Street 1:2519 MILITARY RD
Practice Address - Street 2:SUITE B
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-2498
Practice Address - Country:US
Practice Address - Phone:501-316-5010
Practice Address - Fax:501-316-5014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-14
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR142721002Medicaid
AR134519001Medicaid
AR142721002Medicaid