Basic Information
| Provider Information | |||||||||
| NPI: | 1265459135 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEBLEY | ||||||||
| FirstName: | CARA | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | KIRKS | ||||||||
| OtherFirstName: | CARA | ||||||||
| OtherMiddleName: | L | ||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 34888 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981241888 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4259774620 | ||||||||
| FaxNumber: | 4257459836 | ||||||||
| Practice Location | |||||||||
| Address1: | 21600 HIGHWAY 99 | ||||||||
| Address2: | SUITE 260 | ||||||||
| City: | EDMONDS | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980268012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4257742650 | ||||||||
| FaxNumber: | 4257742643 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2006 | ||||||||
| LastUpdateDate: | 03/19/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | MD00039774 | WA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 0206492 | 01 | WA | LABOR AND INDUSTRIES | OTHER | 1006284 | 05 | WA | MEDICAID |