Provider Demographics
NPI:1306375084
Name:DEPPER, MARY CANDACE (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:CANDACE
Last Name:DEPPER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:CANDACE
Other - Last Name:SELLERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:899 BURNETT DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-2909
Mailing Address - Country:US
Mailing Address - Phone:870-425-6212
Mailing Address - Fax:866-689-4817
Practice Address - Street 1:899 BURNETT DR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-2909
Practice Address - Country:US
Practice Address - Phone:870-425-6212
Practice Address - Fax:866-689-4817
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-07
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-13094207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine