Provider Demographics
NPI:1588085435
Name:DEBLAUW, THOMAS (PA-C)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:DEBLAUW
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 COWLES ST
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-5914
Mailing Address - Country:US
Mailing Address - Phone:907-374-0432
Mailing Address - Fax:907-374-9932
Practice Address - Street 1:1905 COWLES ST
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-5914
Practice Address - Country:US
Practice Address - Phone:907-374-0432
Practice Address - Fax:907-374-9932
Is Sole Proprietor?:No
Enumeration Date:2013-12-19
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2311363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant