Individual
BRIAN A DEPREST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4420 DIXIE HWY, STE. 114, LOUISVILLE, KY 40216-2986
(502) 449-6464
(502) 449-6465
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
32078
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000350656
ANTHEM / NMA
—
01
—
000052155P
HUMANA / NMA
—
01
—
009856
SIHO / NMA
—
01
—
1049449
PASSPORT / NMA
—
01
—
1193589
CHA / NMA
—
01
—
1223284004
CIGNA / NMA
—
01
—
2432515000
PASSPORT ADVANTAGE / NMA
—
05
—
64320781
—
KY
01
—
P00176786
RAILROAD MEDICARE
KY
Enumeration date
04/18/2006
Last updated
04/26/2023
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