Provider Demographics
NPI:1568567410
Name:DEPERRO, DEAN SR (DO)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:
Last Name:DEPERRO
Suffix:SR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 5TH ST SE
Mailing Address - Street 2:SUITE C
Mailing Address - City:BARBERTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-4259
Mailing Address - Country:US
Mailing Address - Phone:330-645-6463
Mailing Address - Fax:330-645-6462
Practice Address - Street 1:101 5TH ST SE
Practice Address - Street 2:SUITE C
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203-4259
Practice Address - Country:US
Practice Address - Phone:330-645-6463
Practice Address - Fax:330-645-6462
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006535D207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2087254Medicaid
OHP00703109OtherRAILROAD CARE
OH2087254Medicaid
OH0856997Medicare PIN
OHP00703109OtherRAILROAD CARE