Individual
MR. STEPHEN P DEPORTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
APN
Contact information
Practice address
1227 E RUSHOLME ST, DAVENPORT, IA 52803-2459
(563) 421-1000
Mailing address
1227 E RUSHOLME ST, DAVENPORT, IA 52803-2459
(563) 421-7681
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
A-081354
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
056857
HEALTH ALLIANCE
—
01
—
185922
IOWA HEALTH SOLUTIONS
—
01
—
4796890020
DMERC
—
01
—
IL01G2
JOHN DEERE HEALTH PLAN
—
Enumeration date
06/16/2005
Last updated
05/06/2021
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