Provider Demographics
NPI:1043278427
Name:DEPERI, JOHN D (M D)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:D
Last Name:DEPERI
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3627 UNIVERSITY BLVD S
Mailing Address - Street 2:SUITE 700
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4230
Mailing Address - Country:US
Mailing Address - Phone:904-399-5678
Mailing Address - Fax:904-399-8488
Practice Address - Street 1:146 E HOSPITAL DR STE 400
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-4800
Practice Address - Country:US
Practice Address - Phone:803-936-3300
Practice Address - Fax:803-936-7735
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC86833208600000X
FLME79425208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
278558OtherAVMED
7528092OtherAETNA
FL004359200Medicaid
6427217OtherCIGNA
51834OtherBCBS FL
P00062696OtherRAILROAD MEDICARE
278558OtherAVMED
6427217OtherCIGNA