| Doctor Name: | STEPHEN P DEPORTER |
| NPI Number: | 1639174519 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | APN |
| License Number: | A-081354 |
| Business Practice Address: | 306 46th Ave East Moline, IL - 612444281 |
| Business Phone Number: | 3097962329 |
| Business Fax Number: | 3097961146 |
| Mailing Address: | 306 46th Ave, EAST MOLINE |
| State: | IL |
| Postal Code: | 612444281 |
| Phone Number: | 3097962329 |
| Fax Number: | 3097961146 |
| NPI Enumeration Date: | 06/16/2005 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | A-081354 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |