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: N

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 PAVILION WAY
SOUTHERN PINES NC
28387-4561
US

IV. Provider business mailing address

205 PAGE RD
PINEHURST NC
28374-8798
US

V. Phone/Fax

Practice location:
  • Phone: 910-246-4140
  • Fax: 910-695-2192
Mailing address:
  • Phone: 910-298-5511
  • Fax: 910-235-3443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number2026-04636
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2026-04636
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: