Provider Demographics
NPI:1700074077
Name:DAVID A. DEPP, M.D. LLC
Entity Type:Organization
Organization Name:DAVID A. DEPP, M.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEPP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-769-9631
Mailing Address - Street 1:8032 SUMMA AVE
Mailing Address - Street 2:STE:D
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3478
Mailing Address - Country:US
Mailing Address - Phone:225-769-9631
Mailing Address - Fax:225-769-9602
Practice Address - Street 1:8032 SUMMA AVE
Practice Address - Street 2:STE:D
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3478
Practice Address - Country:US
Practice Address - Phone:225-769-9631
Practice Address - Fax:225-769-9602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA010566208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1161659Medicaid
LAB89037Medicare UPIN
LA5CB08Medicare PIN