Individual
DR. KENNETH P DEPERSIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
053329
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
053329
MEDICAL LICENSE
GA
01
—
205778734002
TRICARE
—
01
—
341176
WELLCARE OF GEORGIA
GA
05
—
904817618C
—
GA
05
—
904817618D
—
GA
01
—
956500
BCBS
GA
01
—
GRP7930
MEDICARE GROUP # EFFECTIVE 02/01/2008
GA
01
—
P00127268
RAILROAD MEDICARE
GA
Enumeration date
02/27/2006
Last updated
03/07/2023
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