Provider Demographics
NPI:1457578171
Name:EPPERLY, JOHN ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ROBERT
Last Name:EPPERLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 N MAPLE
Mailing Address - Street 2:
Mailing Address - City:NEW HAMPTON
Mailing Address - State:IA
Mailing Address - Zip Code:50659
Mailing Address - Country:US
Mailing Address - Phone:641-394-1633
Mailing Address - Fax:641-394-1999
Practice Address - Street 1:301 N MAPLE
Practice Address - Street 2:
Practice Address - City:NEW HAMPTON
Practice Address - State:IA
Practice Address - Zip Code:50659
Practice Address - Country:US
Practice Address - Phone:641-394-1633
Practice Address - Fax:641-394-1999
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-32559207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200549120DMedicaid
KS200549120DMedicaid
KS110150008Medicare PIN