Provider Demographics
NPI:1831131127
Name:DEPUE, AMY LOUISE (DO)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:LOUISE
Last Name:DEPUE
Suffix:
Gender:F
Credentials:DO
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 9101
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-9494
Mailing Address - Country:US
Mailing Address - Phone:972-745-7500
Mailing Address - Fax:972-745-4336
Practice Address - Street 1:5301 WILLIAM D TATE AVE
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-7357
Practice Address - Country:US
Practice Address - Phone:817-251-2101
Practice Address - Fax:817-421-5041
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4078207Q00000X
CA20A11330207Q00000X
TXP2634207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine