Provider Demographics
NPI:1730523416
Name:WAFER, DEBORAH (MD)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:
Last Name:WAFER
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 1:500 WILLIAM STREET
Mailing Address - Street 2:#335
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-1191
Mailing Address - Country:US
Mailing Address - Phone:510-283-3526
Mailing Address - Fax:510-879-7367
Practice Address - Street 1:500 WILLIAM ST
Practice Address - Street 2:#335
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-1183
Practice Address - Country:US
Practice Address - Phone:510-283-3526
Practice Address - Fax:510-879-7367
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG41873207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine