Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | ED0108B | WV |
N | 111NI0900X | Internist | ED0108B | WV |
Y | 207R00000X | Internist | P7803 | TX |
Y | 111NI0900X | Internist | P7803 | TX |
N | 207RC0200X | Critical Care Medicine | P7803 | TX |
NPI | 1093095127 |
---|---|
Provider Name | Dr. Drew Taylor Lupton |
First Address | Dallas, TX 75208-2312 |
Second Address | Dallas, TX 75208-2312 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2011 |
Last Update Date | 11/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ED0108B | EDUCATIONAL PERMIT NUMBER (01) | WV |