Healthcare Provider Details

I. General information

NPI: 1093862500
Provider Name (Legal Business Name): MR. DUTCH EPPERSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 N BLACKSTONE AVE
FRESNO CA
93701-1914
US

IV. Provider business mailing address

3827 N ATLAS WAY
FRESNO CA
93705-2210
US

V. Phone/Fax

Practice location:
  • Phone: 559-498-0241
  • Fax: 559-498-6220
Mailing address:
  • Phone: 559-226-2391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: