Provider Demographics
NPI:1992767784
Name:DEMARAIS, DEBORAH ANNE (MD)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:ANNE
Last Name:DEMARAIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6401 UNIVERSITY AVE NE
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-4341
Mailing Address - Country:US
Mailing Address - Phone:763-572-5710
Mailing Address - Fax:763-571-3008
Practice Address - Street 1:13819 HANSON BLVD NW
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MN
Practice Address - Zip Code:55304-7608
Practice Address - Country:US
Practice Address - Phone:763-572-5710
Practice Address - Fax:763-862-4490
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN30250208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4134987OtherAETNA
MN24161OtherAMERICA'S PPO
MN1200395OtherMEDICA
MN674508300Medicaid
MNHP19874OtherHEALTHPARTNERS
MN08F19DEOtherBCBS OF MN
MN1000890OtherPREFERRED ONE
MN107287OtherUCARE MN
MN6603947OtherMEDICA UC
MN08F19DEOtherBCBS OF MN
MN370001917Medicare ID - Type Unspecified
MN370001685Medicare ID - Type UnspecifiedMEDICARE RR