Provider Demographics
NPI:1851492771
Name:DEPNER, DANIEL J (PA-C)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:DEPNER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5011 W ALCOTT CT
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-9141
Mailing Address - Country:US
Mailing Address - Phone:509-879-0039
Mailing Address - Fax:509-466-4798
Practice Address - Street 1:309 E FARWELL RD
Practice Address - Street 2:STE 204
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-8207
Practice Address - Country:US
Practice Address - Phone:509-879-0039
Practice Address - Fax:509-466-4798
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10001774363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8404352Medicaid
WA8404352Medicaid
8855031Medicare ID - Type Unspecified