Provider Demographics
NPI:1386608198
Name:DEPUTRON, DAVID (DO)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:DEPUTRON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:CRAIG
Other - Last Name:DEPUTRON
Other - Suffix:JR
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:13838 US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-3296
Mailing Address - Country:US
Mailing Address - Phone:772-581-6900
Mailing Address - Fax:772-589-6995
Practice Address - Street 1:13836 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-3296
Practice Address - Country:US
Practice Address - Phone:772-581-6900
Practice Address - Fax:772-589-6995
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2012-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 3229207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL80186OtherFLORIDA BLUE SHIELD
FL110228924OtherRAILROAD MEDICARE
FL80186OtherFLORIDA BLUE SHIELD
FLE56884Medicare UPIN