Basic Information
| Provider Information | |||||||||
| NPI: | 1033110382 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEPPE | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | TIMOTHY | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1155 W JEFFERSON ST | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | FRANKLIN | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461312730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3173463883 | ||||||||
| FaxNumber: | 3173463141 | ||||||||
| Practice Location | |||||||||
| Address1: | 1155 W JEFFERSON ST | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | FRANKLIN | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461312730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3173463883 | ||||||||
| FaxNumber: | 3173463141 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2005 | ||||||||
| LastUpdateDate: | 07/24/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | 01025133A | IN | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RP1001X | 01025133A | IN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 10040269DA | 05 | IN | MEDICAID |