Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 16935 | WV |
NPI | 1205804374 |
---|---|
Provider Name | Mr. Robert Todd Depond |
First Address | Charleston, WV 25302-3302 |
Second Address | Charleston, WV 25302-3302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2006 |
Last Update Date | 07/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0092833000 | (05) | WV |
F83402 | (02) | WV |