Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 18914 | OR |
NPI | 1194733519 |
---|---|
Provider Name | Dr. Joel Michael Depper |
First Address | Bend, OR 97701-4331 |
Second Address | Bend, OR 97701-4331 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 08/07/2007 |