Healthcare Provider Details

I. General information

NPI: 1083172936
Provider Name (Legal Business Name): EUGENE WAYNE DUPAS JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2019
Last Update Date: 03/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7628 TAZEWELL PIKE
CORRYTON TN
37721-2910
US

IV. Provider business mailing address

828 CARTER VIEW LN
KNOXVILLE TN
37924-3442
US

V. Phone/Fax

Practice location:
  • Phone: 225-892-0212
  • Fax:
Mailing address:
  • Phone: 225-892-0212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number876
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: