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General NPI Number Information
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NPI Number | 1407054539
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Entity Type | Organization
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Legal Business Name | JEFFERSON M TRUPP MD PC
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Dates
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Enumeration Date | 07/10/2007
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Last Update Date | 07/10/2007
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Provider Practice Location Address
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Address Line | 1320 LEIGHTON AVE STE A
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City | ANNISTON
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State | AL
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Zip | 36207-4614
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Country | US
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Telephone | 256-236-5358
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Fax | 256-236-3657
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Provider Business Mailing Address
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Address Line | 1320 LEIGHTON AVE STE A
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City | ANNISTON
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State | AL
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Zip | 36207-4614
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Country | US
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Telephone | 256-236-5358
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Fax | 256-236-3657
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. MARGARET S PORTER
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Credential | CPC
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Telephone | 256-236-5358
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0203X
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Taxonomy Name | Radiation Oncology Clinic/Center
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License Number | 11479
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License Number State | AL
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