Provider Demographics
NPI:1487821898
Name:DEPA, SREEKANTH R (MD)
Entity Type:Individual
Prefix:
First Name:SREEKANTH
Middle Name:R
Last Name:DEPA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:225-526-0002
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:309 JACKSON ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-7407
Practice Address - Country:US
Practice Address - Phone:318-966-4541
Practice Address - Fax:318-966-4543
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2021-08-31
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Provider Licenses
StateLicense IDTaxonomies
LA204806207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine