Provider Demographics
NPI:1437248044
Name:DEBAUCHE, THOMAS LEON (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:LEON
Last Name:DEBAUCHE
Suffix:
Gender:M
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:PO BOX 5127
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206-5127
Mailing Address - Country:US
Mailing Address - Phone:206-860-5414
Mailing Address - Fax:206-720-8462
Practice Address - Street 1:3901 HOYT AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4918
Practice Address - Country:US
Practice Address - Phone:425-339-5453
Practice Address - Fax:425-257-1423
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD6143483207RC0000X
TXF5884207RC0000X
IDM-17309207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
060003218OtherRAILROAD MEDICARE
060003218OtherRAILROAD MEDICARE
TX116077201Medicaid
060003218OtherRAILROAD MEDICARE