Healthcare Provider Details

I. General information

NPI: 1871910745
Provider Name (Legal Business Name): RALPH A. DUPREE, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2014
Last Update Date: 03/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

243 KEO KEO ROAD
ELEELE HI
96705
US

IV. Provider business mailing address

PO BOX 50900 ELEELE
ELEELE HI
96705-0900
US

V. Phone/Fax

Practice location:
  • Phone: 808-634-1548
  • Fax: 209-336-6406
Mailing address:
  • Phone: 808-634-1548
  • Fax: 209-336-6406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number8480
License Number StateHI

VIII. Authorized Official

Name: RALPH ANTHONY DUPREE
Title or Position: PHYSICIAN
Credential: MD
Phone: 808-634-1548