Provider Demographics
NPI:1043473358
Name:DAVID A DEBENHAM MD PC
Entity type:Organization
Organization Name:DAVID A DEBENHAM MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEBENHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-656-0029
Mailing Address - Street 1:620 S 400 E
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-3700
Mailing Address - Country:US
Mailing Address - Phone:435-656-0029
Mailing Address - Fax:435-656-9144
Practice Address - Street 1:620 S 400 E
Practice Address - Street 2:SUITE 201
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3700
Practice Address - Country:US
Practice Address - Phone:435-656-0029
Practice Address - Fax:435-656-9144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-07
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT184722-1205207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty