Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | R7857 | IA |
N | 208600000X | Surgeon | R7857 | IA |
N | 2086X0206X | Surgical Oncologist | 2014-00152 | NC |
Y | 2086X0206X | Surgical Oncologist | 303750 | LA |
N | 2086X0206X | Surgical Oncologist | P6366 | TX |
NPI | 1275742470 |
---|---|
Provider Name | Julie A Cupp |
First Address | Shreveport, LA 71105-5505 |
Second Address | Shreveport, LA 71105-5505 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 23/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
329507301 | (05) | TX |