Provider Demographics
NPI:1669408076
Name:GROUSE, DEBORAH J (MD)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:J
Last Name:GROUSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:361 HOSPITAL ROAD
Mailing Address - Street 2:#533
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3522
Mailing Address - Country:US
Mailing Address - Phone:949-650-7200
Mailing Address - Fax:949-650-2873
Practice Address - Street 1:361 HOSPITAL ROAD
Practice Address - Street 2:#533
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3522
Practice Address - Country:US
Practice Address - Phone:949-650-7200
Practice Address - Fax:949-650-2873
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG71740207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW10780AOtherPTAN
CAF57332Medicare UPIN
CAWG71740BMedicare PIN