Healthcare Provider Details

I. General information

NPI: 1104802495
Provider Name (Legal Business Name): MICHAEL D DUPRE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 07/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 PLAZA DR
PELL CITY AL
35125-9370
US

IV. Provider business mailing address

74 PLAZA DR
PELL CITY AL
35125-9370
US

V. Phone/Fax

Practice location:
  • Phone: 205-814-9284
  • Fax: 205-814-9626
Mailing address:
  • Phone: 205-814-9284
  • Fax: 205-814-9626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20186
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: