Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 01045008A | IN |
NPI | 1013903541 |
---|---|
Provider Name | Jonathan Baker Lupton |
First Address | Indianapolis, IN 46237-8600 |
Second Address | Indianapolis, IN 46237-8633 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2005 |
Last Update Date | 07/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200094030A | (05) | IN |
G24307 | (02) | IN |