Healthcare Provider Details

I. General information

NPI: 1043607138
Provider Name (Legal Business Name): GEORGE LUPAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: GHEORGHE LUPAS D.O.

II. Dates (important events)

Enumeration Date: 04/16/2015
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1718 E KESSLER BLVD
LONGVIEW WA
98632-1842
US

IV. Provider business mailing address

203 S WESTERN AVE
TONASKET WA
98855-8803
US

V. Phone/Fax

Practice location:
  • Phone: 360-747-5800
  • Fax: 360-575-3846
Mailing address:
  • Phone: 509-486-3191
  • Fax: 509-223-1743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOP60852965
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: