Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1609857341 Individual Practitioner Male Practitioner

Dr. Ebba K. Ebba , MD

Pediatrics • Fort Defiance, AZ

Professional Overview & Biography Verified Profile Summary

Dr. Ebba Ebba, MD is a registered healthcare professional specializing in Pediatrics in Fort Defiance, AZ. Practice services are available at CORNER OF ROUTE N12 AND N7 under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

Corner Of Route N12 And N7

Fort Defiance, AZ 865040649

Telephone 9287298000
Associated Practice Facility / Clinic

Specialty Benchmarks & Practice Insights

Comparative analytics for Pediatrics in Fort Defiance, AZ

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 23.5 Yrs
Regional Practice Density
19 Specialists

Practicing in Fort Defiance, AZ (1353 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2026-08-04
Pediatrics Primary Specialty

NUCC Taxonomy Code: 208000000X

State License GA 36724

A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.

Pediatrics

NUCC Taxonomy Code: 208000000X

State License KY 50869

A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.

Pediatrics

NUCC Taxonomy Code: 208000000X

State License WV 32946

A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.

Pediatrics

NUCC Taxonomy Code: 208000000X

State License KY TP229

A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.

Pediatrics

NUCC Taxonomy Code: 208000000X

State License AL 25659

A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

40 Associated Practitioners
Dr. Rebecca Reeve , PharmD

Pharmacist - Ambulatory Care

NPI 1003451600

Doctor of Pharmacy (Pharm.D.)

NPI 1003512070

Physical Therapist, Doctor of Physical Therapy

Kevin Boudinot

Respiratory Therapist, Registered - Critical Care

NPI 1003549304
Lilia Janzen-Trotsyuk

Registered Nurse

NPI 1013629856
Anthony Magdadaro

Registered Nurse

NPI 1023724614
Jay Guikema , FNP

Nurse Practitioner - Family

NPI 1033289319

Family Nurse Practitioner

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

24 Historical Events
🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) August 04, 2026

Pediatrics (License #50869 in KY)

📍
Updated Practice Location May 13, 2025

Registered at CORNER OF ROUTE N12 AND N7, FORT DEFIANCE, AZ 865040649 (Tel: 9287298000)

📍
Updated Business Mailing Address May 13, 2025

Registered at PO BOX 649, FORT DEFIANCE, AZ 865040649

📍
Updated Practice Location April 26, 2024

Registered at 812 GORMAN AVE, ELKINS, WV 262413181 (Tel: 3046363300)

📍
Updated Business Mailing Address April 26, 2024

Registered at 812 GORMAN AVE, ELKINS, WV 262413181 (Tel: 3046363300)

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) April 26, 2024

Pediatrics (License #36724 in GA)

📍
Updated Practice Location April 27, 2021

Registered at 455 LEE ST SW FL 2, ATLANTA, GA 303101408 (Tel: 4047521000)

📍
Updated Business Mailing Address April 27, 2021

Registered at 720 WESTVIEW DRIVE SW, HARRIS BLDG., 100-A, ATLANTA, GA 30310

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) April 27, 2021

Pediatrics (License #TP229 in KY)

📍
Updated Practice Location August 08, 2019

Registered at 1238 FALLS RD, TOCCOA, GA 30577 (Tel: 7062827337)

📍
Updated Business Mailing Address August 08, 2019

Registered at 163 HOSPITAL DR, TOCCOA, GA 305776820 (Tel: 7062824200)

📍
Updated Practice Location July 13, 2018

Registered at 226 MEDICAL PLAZA LN, WHITESBURG, KY 41858 (Tel: 6066334871)

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) July 13, 2018

Pediatrics (License #25659 in AL)

NPI Profile Active October 31, 2017

NPI status registered as active in NPPES database

📍
Updated Practice Location October 31, 2017

Registered at 226 MEDICAL PLAZA LN, WHITESBURG, KY 418587425 (Tel: 6066334871)

📍
Updated Business Mailing Address October 31, 2017

Registered at PO BOX 40, WHITESBURG, KY 418580040 (Tel: 6066334823)

👤
Provider Name / Credentials Updated October 31, 2017

Recorded as EBBA EBBA, M.D

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) October 31, 2017

Pediatrics (License #TP229 in KY)

NPI Profile Active September 02, 2014

NPI status registered as active in NPPES database

📍
Updated Practice Location September 02, 2014

Registered at 1460 2ND AVE SW, JACKSONVILLE, AL 362653358 (Tel: 2564359422)

📍
Updated Business Mailing Address September 02, 2014

Registered at 1460 2ND AVE SW, JACKSONVILLE, AL 362653358 (Tel: 2564359422)

👤
Provider Name / Credentials Updated September 02, 2014

Recorded as EBBA EBBA, M.D

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) September 02, 2014

Pediatrics (License #25659 in AL)

🟢
Initial NPI Registration & Enumeration November 09, 2005

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1609857341
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: November 09, 2005
Last Update: August 04, 2026
Sole Proprietor: No

Mailing Address

Po Box 649

Fort Defiance, AZ 865040649

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.