Provider Demographics
NPI:1437131422
Name:DEPPE, SCOTT A (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:A
Last Name:DEPPE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3204 MEADOWOOD LN
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59404-5616
Mailing Address - Country:US
Mailing Address - Phone:269-615-2454
Mailing Address - Fax:406-866-0036
Practice Address - Street 1:3204 MEADOWOOD LN
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59404-5616
Practice Address - Country:US
Practice Address - Phone:269-615-2454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60638958207RC0200X
KS0442921207RC0200X
VA0101268966207RC0200X
TXG9448207RC0200X
SD7889207RC0200X
MT68318207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX75-2616977-042OtherTRICARE
SCG40047Medicaid
TXP01927552OtherMEDICARE RAIL ROAD
SD5620080Medicaid
TX376788101Medicaid
GA000666949BMedicaid
TX602952YMAFOtherMEDICARE
SD5620080Medicaid