Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | 01025133A | IN |
Y | 207RP1001X | Pulmonary Disease | 01025133A | IN |
NPI | 1033110382 |
---|---|
Provider Name | Mr. James Timothy Deppe |
First Address | Franklin, IN 46131-2730 |
Second Address | Franklin, IN 46131-2730 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2005 |
Last Update Date | 24/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10040269DA | (05) | IN |
D70852 | (02) |