Provider Demographics
NPI:1790763266
Name:DEPERO, GEORGE (CRNA)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:
Last Name:DEPERO
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 AVENIDA DEL NORTE
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34242
Mailing Address - Country:US
Mailing Address - Phone:941-346-9935
Mailing Address - Fax:
Practice Address - Street 1:1435 S OSPREY AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239
Practice Address - Country:US
Practice Address - Phone:941-366-4475
Practice Address - Fax:941-366-4390
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN2659452367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
G1635Medicare ID - Type Unspecified