Provider Demographics
NPI:1588732960
Name:AMOS, DEBORAH ELLEN (MD)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:ELLEN
Last Name:AMOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:912 32ND ST.
Mailing Address - Street 2:SUITE B
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-2582
Mailing Address - Country:US
Mailing Address - Phone:360-293-5603
Mailing Address - Fax:360-293-6594
Practice Address - Street 1:912 32ND ST.
Practice Address - Street 2:SUITE B
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-2582
Practice Address - Country:US
Practice Address - Phone:360-293-5603
Practice Address - Fax:360-293-6594
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WA32852208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1366510745OtherBUSINESS NPI-FIDALGO SPORTS AND PHYSIATRY
WA91-2145952OtherEIN (DBA FIDALGO SPORTS
WAGAB32785Medicare PIN