Debord, Alan

Debord, Alan is an individual health care provider with primary practice located at 200 E Pennsylvania Ave , Peoria IL 61603-3089. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Debord, Alan can be contacted via phone (309) 655-2045.

Contact Information

Primary practice address
200 E Pennsylvania Ave Peoria IL 61603-3089
Phone: (309) 655-2045
Fax: (309) 655-3057
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 036055826 Illinois

Profile Details

NPI number 1902864796
LBN Legal business name Debord, Alan
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 2nd, 2006
Last updated Jan 10th, 2012 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1902864796 NPPES
Illinois Other 809840 MEDICARE GROUP PTAN
Illinois Other CA4079 MEDICARE GROUP PTAN
Illinois Other P00651196 MEDICARE GROUP PTAN
Illinois MEDICAID 036055826 MEDICARE GROUP PTAN

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