Provider Demographics
NPI:1023897378
Name:DR. PETER DEBELIUS-ENEMARK, LLC
Entity type:Organization
Organization Name:DR. PETER DEBELIUS-ENEMARK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:L PAULINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SABITSCH
Authorized Official - Suffix:
Authorized Official - Credentials:CSPPM
Authorized Official - Phone:850-877-0635
Mailing Address - Street 1:1407 M D LN STE A
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5349
Mailing Address - Country:US
Mailing Address - Phone:850-877-0635
Mailing Address - Fax:850-205-0195
Practice Address - Street 1:1407 M D LN STE A
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5349
Practice Address - Country:US
Practice Address - Phone:850-877-0635
Practice Address - Fax:850-205-0195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty