Healthcare Provider Details

I. General information

NPI: 1699741942
Provider Name (Legal Business Name): WILLIAM D DEPOND M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 02/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

634 BEECH ST
TERRE HAUTE IN
47804-2760
US

IV. Provider business mailing address

PO BOX 9524
TERRE HAUTE IN
47808-9524
US

V. Phone/Fax

Practice location:
  • Phone: 812-244-0100
  • Fax: 812-232-1517
Mailing address:
  • Phone: 812-244-0010
  • Fax: 812-232-1517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number107867
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: