Provider Demographics
NPI:1235116997
Name:DEPOLD, CARRY E (PA C)
Entity Type:Individual
Prefix:MRS
First Name:CARRY
Middle Name:E
Last Name:DEPOLD
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Gender:F
Credentials:PA C
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Mailing Address - Street 1:3640 NEW VISION DR
Mailing Address - Street 2:PROFESSIONAL EMERGENCY PHYSICIANS, SUITE A
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1717
Mailing Address - Country:US
Mailing Address - Phone:260-482-4440
Mailing Address - Fax:260-482-4442
Practice Address - Street 1:2200 RANDALLIA DR
Practice Address - Street 2:PROFESSIONAL EMERGENCY PHYSICIANS
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-4638
Practice Address - Country:US
Practice Address - Phone:260-373-4000
Practice Address - Fax:260-482-4442
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2013-06-04
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Provider Licenses
StateLicense IDTaxonomies
IN10001452A.363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant