Provider Demographics
NPI:1174560163
Name:GREAVES, DEBORAH I (MD)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:I
Last Name:GREAVES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1723 LUCERNE TER
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2916
Mailing Address - Country:US
Mailing Address - Phone:407-843-1180
Mailing Address - Fax:407-841-6160
Practice Address - Street 1:1723 LUCERNE TER
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2916
Practice Address - Country:US
Practice Address - Phone:407-843-1180
Practice Address - Fax:407-841-6160
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME63033207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL18716OtherBCBS
F54892Medicare UPIN
FL18716WMedicare PIN