Provider Demographics
NPI:1366500340
Name:DEPPEY, JAMIE (LMT)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:DEPPEY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 W GLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-7769
Mailing Address - Country:US
Mailing Address - Phone:602-920-2535
Mailing Address - Fax:623-536-1638
Practice Address - Street 1:2222 W GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-7769
Practice Address - Country:US
Practice Address - Phone:602-920-2535
Practice Address - Fax:623-536-1638
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-01983P174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist