Healthcare Provider Details

I. General information

NPI: 1881660348
Provider Name (Legal Business Name): PATRICK JOHN DEPENBROCK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 JOEL DR. BLANCHFIELD ARMY COMMUNITY HOSPITAL
FT. CAMPBELL KY
42223-5349
US

IV. Provider business mailing address

650 JOEL DR. BLANCHFIELD ARMY COMMUNITY HOSPITAL
FT. CAMPBELL KY
42223-5349
US

V. Phone/Fax

Practice location:
  • Phone: 270-798-8372
  • Fax: 270-956-0180
Mailing address:
  • Phone: 270-798-8372
  • Fax: 270-956-0180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101236287
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: