Provider Demographics
NPI:1699775056
Name:CONRAN, DEBORAH L (DO)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:L
Last Name:CONRAN
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 1:1431 ORANGE CAMP RD STE 118
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-7770
Mailing Address - Country:US
Mailing Address - Phone:386-943-3234
Mailing Address - Fax:386-822-5487
Practice Address - Street 1:1431 ORANGE CAMP RD STE 118
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-7770
Practice Address - Country:US
Practice Address - Phone:386-943-3234
Practice Address - Fax:386-822-5487
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH00056241207Q00000X
DEC20008571207Q00000X
MDH0056241207Q00000X
FLOS20695207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL121492100Medicaid
DE0001053003Medicaid
MD351900700Medicaid
DE137021ZA6KG0242Medicare PIN
MDK23067HHMedicare ID - Type Unspecified
MDKP95R580Medicare PIN