Provider Demographics
NPI:1619112109
Name:JOHN, DEEPU (MD)
Entity Type:Individual
Prefix:DR
First Name:DEEPU
Middle Name:
Last Name:JOHN
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:PO BOX 782
Mailing Address - Street 2:
Mailing Address - City:HYDEN
Mailing Address - State:KY
Mailing Address - Zip Code:41749
Mailing Address - Country:US
Mailing Address - Phone:606-672-4860
Mailing Address - Fax:
Practice Address - Street 1:130 KATE IRELAND DRIVE
Practice Address - Street 2:MARY BRECKINRIDGE HOSPITAL
Practice Address - City:HYDEN
Practice Address - State:KY
Practice Address - Zip Code:41749-1779
Practice Address - Country:US
Practice Address - Phone:606-672-2341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-11
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY42237207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine