Provider Demographics
NPI:1992736771
Name:PROW, DEBRA MARIE (MD)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:MARIE
Last Name:PROW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:MARIE
Other - Last Name:REEME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16668 530TH AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:IA
Mailing Address - Zip Code:50105-8704
Mailing Address - Country:US
Mailing Address - Phone:817-308-0919
Mailing Address - Fax:
Practice Address - Street 1:16668 530TH AVE
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:IA
Practice Address - Zip Code:50105-8704
Practice Address - Country:US
Practice Address - Phone:817-308-0919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA37050207RH0003X
TXJ7141207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0746107Medicaid
IAI19486Medicare PIN
TXA17069Medicare UPIN
IA0746107Medicaid