Provider Demographics
NPI:1881616639
Name:ELLIOTT-PEARSON, DEBORAH LOIS (MD)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LOIS
Last Name:ELLIOTT-PEARSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:LOIS
Other - Last Name:ELLIOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:504 S 13TH ST
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:MT
Mailing Address - Zip Code:59047-3727
Mailing Address - Country:US
Mailing Address - Phone:406-823-6414
Mailing Address - Fax:406-823-6287
Practice Address - Street 1:504 S 13TH ST
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:MT
Practice Address - Zip Code:59047-3727
Practice Address - Country:US
Practice Address - Phone:406-222-3541
Practice Address - Fax:406-823-6630
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM7469207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID805230000Medicaid
ID1881616639Medicaid
G39437Medicare UPIN