Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1100X | Ophthalmic |
NPI | 1225278369 |
---|---|
Provider Name | Mary Jo Dupree |
First Address | Kettering, OH 45409-1334 |
Second Address | Kettering, OH 45409-1334 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2009 |
Last Update Date | 03/03/2009 |