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General NPI Number Information
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NPI Number | 1730348103
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Entity Type | Individual
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Provider Name | HANNAH GRUBB DEPPISCH M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/02/2008
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Last Update Date | 09/02/2015
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Provider Practice Location Address
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Address Line | 4800 NE STALLINGS DR SUITE 115
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City | NACOGDOCHES
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State | TX
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Zip | 75965-1250
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Country | US
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Telephone | 936-205-9820
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Fax | 936-205-9819
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Provider Business Mailing Address
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Address Line | 4800 NE STALLINGS DR SUITE 115
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City | NACOGDOCHES
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State | TX
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Zip | 75965-1250
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Country | US
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Telephone | 936-205-9820
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Fax | 936-205-9819
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | N3611
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | N3611
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License Number State | TX
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