Provider Demographics
NPI:1437239746
Name:DOEPKER, JOHN FREDERICK JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:FREDERICK
Last Name:DOEPKER
Suffix:JR
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 1:2701 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-1627
Mailing Address - Country:US
Mailing Address - Phone:812-476-4400
Mailing Address - Fax:812-437-7121
Practice Address - Street 1:2701 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-1627
Practice Address - Country:US
Practice Address - Phone:812-476-4400
Practice Address - Fax:812-437-7121
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01026516A208200000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000851554OtherBC/BS
KY64754690Medicaid
IN100248180Medicaid
KY64754690Medicaid
IL000000000Medicaid
IN836320002Medicare PIN
IN100248180AMedicaid
IN000000085654OtherINDIANA BLUE CROSS BLUE S
KY000000085654OtherKENTUCKY BLUE CROSS BLUE
IN221001OtherWELBORN HEALTHCARE