Provider Demographics
NPI:1699747535
Name:REILAND, DEBORA SUSAN (DO)
Entity type:Individual
Prefix:DR
First Name:DEBORA
Middle Name:SUSAN
Last Name:REILAND
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 3RD ST NW
Mailing Address - Street 2:
Mailing Address - City:ATTALLA
Mailing Address - State:AL
Mailing Address - Zip Code:35954-2022
Mailing Address - Country:US
Mailing Address - Phone:256-538-7273
Mailing Address - Fax:256-538-2514
Practice Address - Street 1:515 3RD ST NW
Practice Address - Street 2:
Practice Address - City:ATTALLA
Practice Address - State:AL
Practice Address - Zip Code:35954-2022
Practice Address - Country:US
Practice Address - Phone:256-538-7273
Practice Address - Fax:256-538-2514
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO169207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL19665Medicare ID - Type Unspecified
ALD80343Medicare UPIN
AL81363Medicare ID - Type Unspecified