Marc W Debow
Individual provider Active NPI Physician Assistant · Staples, MN
NPI 1528059284 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1528059284
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 9085 (MN)
- Practice address
- 49725 County 83
Staples, MN 56479-5280 - Phone
- (218) 894-1515
- Fax
- (218) 894-1316
- NPI assigned
- Nov 2, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9085 | MN | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lakewood Health System | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 9085 | MN | Yes |
Addresses
Primary practice location
49725 County 83
Staples, MN 56479-5280
Mailing address
49725 County 83
Staples, MN 56479-5280
Phone (218) 894-1515
Other providers in Staples, MN
- Mariah Renae Couture
- Avery Cunningham
- Frany Bipinchandra Dadhania
- Larson Davick
- Paul A Davis
- Nathan Thomas Dewey
- Kelsey Mae Dockendorf
- Seth Alan Dokken
- Karen Lynn Dornbusch
- Constance L Dubois
All providers in Staples, MN · Physician Assistant in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.