Provider Demographics
NPI:1972894590
Name:DOUD, DEBRA (MD)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:DOUD
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 1:463 CARLTON ST
Mailing Address - Street 2:
Mailing Address - City:WAUCHULA
Mailing Address - State:FL
Mailing Address - Zip Code:33873-3400
Mailing Address - Country:US
Mailing Address - Phone:863-767-0522
Mailing Address - Fax:863-767-0572
Practice Address - Street 1:463 CARLTON ST
Practice Address - Street 2:
Practice Address - City:WAUCHULA
Practice Address - State:FL
Practice Address - Zip Code:33873-3400
Practice Address - Country:US
Practice Address - Phone:863-767-0522
Practice Address - Fax:863-767-0572
Is Sole Proprietor?:No
Enumeration Date:2011-04-30
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036075766207R00000X
FLME111252207R00000X, 207RC0000X
CAC54845207R00000X, 207RC0000X
IL036.075766207RC0000X
MN76218207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008155800Medicaid
FL008155800Medicaid
FLHD917YMedicare UPIN