Provider Demographics
NPI:1962487561
Name:DEPNER, THOMAS A (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:A
Last Name:DEPNER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4150 V ST
Mailing Address - Street 2:NEPHROLOGY DIVISION #3500 PSSB
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-1460
Mailing Address - Country:US
Mailing Address - Phone:916-734-3014
Mailing Address - Fax:916-734-7920
Practice Address - Street 1:4150 V ST
Practice Address - Street 2:NEPHROLOGY DIVISION #3500 PSSB
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-1460
Practice Address - Country:US
Practice Address - Phone:916-734-3014
Practice Address - Fax:916-734-7920
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG025912207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG025912OtherMEDICAL LICENSE