| Deborah Desouza, | |
|
109 W Wall St, Frostproof, FL 33843-2043 | |
| (866) 234-8534 | |
| Not Available |
| Full Name | Deborah Desouza |
|---|---|
| Gender | Female |
| Speciality | Family Medicine |
| Location | 109 W Wall St, Frostproof, Florida |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821402561 | NPI | - | NPPES |
| 1578813531 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 55870 (Tennessee) | Secondary |
| 207Q00000X | Family Medicine | ME126092 (Florida) | Primary |
| Entity Name | Medicos General Pllc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1952402885 PECOS PAC ID: 1052362167 Enrollment ID: O20050207000376 |
| Entity Name | The Camellia Foundation |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1609169713 PECOS PAC ID: 0547439606 Enrollment ID: O20110805000223 |
| Entity Name | Memphis Urgent Care #2 Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1164840609 PECOS PAC ID: 0648407023 Enrollment ID: O20131210000737 |
| Mailing Address | Practice Location Address |
|---|---|
| Deborah Desouza, 47 5th St Nw, Winter Haven, FL 33881-4672 Ph: (866) 234-8534 | Deborah Desouza, 109 W Wall St, Frostproof, FL 33843-2043 Ph: (866) 234-8534 |
Heather Marie Lutz, DO Family Medicine Medicare: Medicare Enrolled Practice Location: 109 W Wall St, Frostproof, FL 33843 Phone: 963-635-4891 Fax: 963-635-3545 | |
Dr. Fabiola Dutes Fairgrieve, M.D. J.D. Family Medicine Medicare: Not Enrolled in Medicare Practice Location: 109 W Wall St, Frostproof, FL 33843 Phone: 866-234-8534 |