| Doctor Name: | DR. DEBORAH LANE GHANDOUR |
| NPI Number: | 1053329599 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C, DHSC |
| License Number: | PA9101774 |
| Business Practice Address: | 1361 13th Ave S Suite 150 Jacksonville Beach, FL - 322503233 |
| Business Phone Number: | 9042427177 |
| Business Fax Number: | 9042427433 |
| Mailing Address: | 1361 13th Ave S, Suite 150 JACKSONVILLE BEACH |
| State: | FL |
| Postal Code: | 322503233 |
| Phone Number: | 9042427177 |
| Fax Number: | 9042427433 |
| NPI Enumeration Date: | 08/03/2006 |
| NPI Last Update Date: | 08/21/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | PA9101774 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |