Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 031590 | GA |
N | 111NI0900X | Internist | 031590 | GA |
Y | 207RP1001X | Pulmonary Disease | 031590 | GA |
NPI | 1043222649 |
---|---|
Provider Name | John R Dupre |
First Address | Griffin, GA 30224-4214 |
Second Address | Griffin, GA 30224-4214 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2006 |
Last Update Date | 30/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000518746C | (05) | GA |
E25178 | (02) |