Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 0101048512 | VA |
NPI | 1003933953 |
---|---|
Provider Name | Patricia Ann Duprey |
First Address | Danville, VA 24543-5025 |
Second Address | Danville, VA 24541-5167 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
36274 | BLUE CROSS BLUE SHIELD (01) | VA |
E71008 | (02) |