Provider Demographics
NPI:1790135663
Name:DEPOE, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:DEPOE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 A ST NE
Mailing Address - Street 2:102 A NE
Mailing Address - City:MIAMI
Mailing Address - State:OK
Mailing Address - Zip Code:74354-6332
Mailing Address - Country:US
Mailing Address - Phone:918-801-3500
Mailing Address - Fax:
Practice Address - Street 1:102 A ST NE
Practice Address - Street 2:102 A NE
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-6332
Practice Address - Country:US
Practice Address - Phone:918-801-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator