Healthcare Provider Details

I. General information

NPI: 1407021009
Provider Name (Legal Business Name): JAMES DINAKAR MOPUR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2008
Last Update Date: 09/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 W FRANK AVE
LUFKIN TX
75904-3357
US

IV. Provider business mailing address

501 CROWN COLONY DR
LUFKIN TX
75901-7715
US

V. Phone/Fax

Practice location:
  • Phone: 936-634-8111
  • Fax:
Mailing address:
  • Phone: 224-622-3196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberN0998
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: