Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080N0001X | Neonatal-Perinatal Doctor | M8636 | TX |
Y | 2080N0001X | Neonatal-Perinatal Doctor | MD2011-0413 | NM |
NPI | 1104047265 |
---|---|
Provider Name | Tara Lynn Dupont |
First Address | Albuquerque, NM 87106-4374 |
Second Address | Albuquerque, NM 87106-2745 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 21/10/2021 |