Provider Demographics
NPI:1538168851
Name:ANDERSON, DEBORAH A (MD)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:A
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:325 MAINE STREET
Mailing Address - Street 2:MSO LIBRARY
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-1360
Mailing Address - Country:US
Mailing Address - Phone:785-505-2988
Mailing Address - Fax:785-505-5228
Practice Address - Street 1:1130 W 4TH ST STE 3200
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-1346
Practice Address - Country:US
Practice Address - Phone:785-505-5850
Practice Address - Fax:785-505-5268
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2020-11-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS430518207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200269370AMedicaid
KS200269370AMedicaid