Provider Demographics
NPI:1689677361
Name:DEPPER, JANE A (MD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:A
Last Name:DEPPER
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1720 LOUISIANA BLVD NE
Mailing Address - Street 2:STE 401
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-7020
Mailing Address - Country:US
Mailing Address - Phone:505-260-4300
Mailing Address - Fax:505-260-4338
Practice Address - Street 1:1100 CENTRAL AVE SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4930
Practice Address - Country:US
Practice Address - Phone:505-841-1234
Practice Address - Fax:505-841-1956
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-24
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NM94-230207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM07654073Medicaid
CO83757503Medicaid
AZ702755Medicaid
NM74926Medicaid
NMNM009649OtherBLUE CROSS BLUE SHIELD
NM170926OtherPRONET / AETNA
AZ702755Medicaid