Provider Demographics
NPI:1053590489
Name:BALLIRAM MANOHALAL, DEBRA B (DO)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:B
Last Name:BALLIRAM MANOHALAL
Suffix:
Gender:F
Credentials:DO
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Other - Credentials:
Mailing Address - Street 1:770 NORTHPOINT PARKWAY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407
Mailing Address - Country:US
Mailing Address - Phone:561-275-7604
Mailing Address - Fax:561-802-5385
Practice Address - Street 1:1447 MEDICAL PARK BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-3164
Practice Address - Country:US
Practice Address - Phone:561-790-5990
Practice Address - Fax:561-790-5952
Is Sole Proprietor?:No
Enumeration Date:2007-11-01
Last Update Date:2017-09-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLOS10052207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL280386100Medicaid
FL280386100Medicaid