Basic Information
| Provider Information | |||||||||
| NPI: | 1184888125 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEMRY | ||||||||
| FirstName: | DEBRA | ||||||||
| MiddleName: | SUE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10365 W SAMPLE RD | ||||||||
| Address2: | |||||||||
| City: | CORAL SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330653941 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543446550 | ||||||||
| FaxNumber: | 9543448634 | ||||||||
| Practice Location | |||||||||
| Address1: | 10365 W SAMPLE RD | ||||||||
| Address2: | |||||||||
| City: | CORAL SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330653941 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543446550 | ||||||||
| FaxNumber: | 9543448634 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2008 | ||||||||
| LastUpdateDate: | 07/17/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.