Provider Demographics
NPI:1699762781
Name:GANT, DEBORAH LOUISE (MD)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:LOUISE
Last Name:GANT
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 1:2017 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-5501
Mailing Address - Country:US
Mailing Address - Phone:281-485-9990
Mailing Address - Fax:281-485-9469
Practice Address - Street 1:2017 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-5501
Practice Address - Country:US
Practice Address - Phone:281-485-9990
Practice Address - Fax:281-485-9469
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7609208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00H95YMedicare PIN