=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629098066
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHRISTOPHER R. DEPNER,M.D.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12 MARTIN ST
-----------------------------------------------------
City | WELLSVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14895-1057
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-593-4250
-----------------------------------------------------
Fax | 585-593-2465
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12 MARTIN ST
-----------------------------------------------------
City | WELLSVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14895-1057
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-593-4250
-----------------------------------------------------
Fax | 585-593-2465
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CHRISTOPHER R DEPNER
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 585-593-4250
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 173875-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------