Provider Demographics
NPI:1659371177
Name:DEPPEN, JEFFREY GERARD (DO)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:GERARD
Last Name:DEPPEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:2720 S WASHINGTON AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-2873
Mailing Address - Country:US
Mailing Address - Phone:517-487-8255
Mailing Address - Fax:517-487-2059
Practice Address - Street 1:2720 S WASHINGTON AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-2873
Practice Address - Country:US
Practice Address - Phone:517-487-8255
Practice Address - Fax:517-487-2059
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2010-04-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101014681208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI53311215OtherBCBSM
MI4748047Medicaid
MICA3383OtherRAILROAD MEDICARE
MI020C311510OtherBCBSM
MI200000001870OtherPHP MEDICAID
MI1015391OtherMCLAREN HEALTH PLAN
MI1015391OtherINGHAM HEALTH PLAN
MI200000001870OtherPHYSICIANS HEALTH PLAN
MICA3383OtherRAILROAD MEDICARE
MI1015391OtherINGHAM HEALTH PLAN