Provider Demographics
NPI:1487471348
Name:STALLMAN, DEBORAH DIGRANDE
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:DIGRANDE
Last Name:STALLMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19231 MONASTERY DR
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-9214
Mailing Address - Country:US
Mailing Address - Phone:907-696-1441
Mailing Address - Fax:
Practice Address - Street 1:19231 MONASTERY DR
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-9214
Practice Address - Country:US
Practice Address - Phone:907-696-1441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKMEDO3651207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine