Provider Demographics
NPI:1902804933
Name:BURRIS, DEBRA L (MD)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:L
Last Name:BURRIS
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 1:659 BROWNSWITCH RD
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-1233
Mailing Address - Country:US
Mailing Address - Phone:985-641-5558
Mailing Address - Fax:985-649-6487
Practice Address - Street 1:110 VETERANS MEMORIAL BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70005-3027
Practice Address - Country:US
Practice Address - Phone:504-831-6760
Practice Address - Fax:504-831-6964
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0147182084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1320536Medicaid
LA1320536Medicaid
B60345Medicare UPIN