Healthcare Provider Details

I. General information

NPI: 1972952406
Provider Name (Legal Business Name): GREGORIE BUPE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2016
Last Update Date: 04/27/2025
Certification Date: 04/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 HODGES DR
TALLAHASSEE FL
32308
US

IV. Provider business mailing address

1301 HODGES DR
TALLAHASSEE FL
32308-4614
US

V. Phone/Fax

Practice location:
  • Phone: 850-431-5430
  • Fax:
Mailing address:
  • Phone: 850-431-5430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number39626
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME139912
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: