Basic Information
| Provider Information | |||||||||
| NPI: | 1558391524 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TREACY | ||||||||
| FirstName: | DEBORAH | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 103 N OAK ST | ||||||||
| Address2: | |||||||||
| City: | O FALLON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622691165 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6186243368 | ||||||||
| FaxNumber: | 6186243387 | ||||||||
| Practice Location | |||||||||
| Address1: | 103 N OAK ST | ||||||||
| Address2: | |||||||||
| City: | O FALLON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622691165 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6186243368 | ||||||||
| FaxNumber: | 6186243387 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/04/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 207P00000X | IL | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.