Basic Information
Provider Information
NPI: 1417122896
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ROESSLER
FirstName: DEBORAH
MiddleName: M.
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 709 W ORCHARD DR
Address2: SUITE #4
City: BELLINGHAM
State: WA
PostalCode: 982251766
CountryCode: US
TelephoneNumber: 3603188800
FaxNumber: 3603181085
Practice Location
Address1: 3015 SQUALICUM PKWY
Address2: SUITE 120
City: BELLINGHAM
State: WA
PostalCode: 982251945
CountryCode: US
TelephoneNumber: 3607337974
FaxNumber: 3606762567
Other Information
ProviderEnumerationDate: 04/25/2008
LastUpdateDate: 06/04/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/04/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XMD60271735WAY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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