Provider Demographics
NPI:1831161678
Name:DEPENDER, WILLIAM JAMES (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JAMES
Last Name:DEPENDER
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 1:3387 FOX SPIT RD
Mailing Address - Street 2:
Mailing Address - City:LANGLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98260-9321
Mailing Address - Country:US
Mailing Address - Phone:360-730-1267
Mailing Address - Fax:
Practice Address - Street 1:BMC EVERETT
Practice Address - Street 2:2000 W MARINE VIEW DR
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98207-0001
Practice Address - Country:US
Practice Address - Phone:425-304-4099
Practice Address - Fax:425-304-4082
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00022742207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1007715Medicaid
WA1007715Medicaid