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General NPI Number Information
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NPI Number | 1871552638
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Entity Type | Individual
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Provider Name | JEFFERSON MASON TRUPP MD
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Gender | Male
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Dates
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Enumeration Date | 03/21/2006
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Last Update Date | 12/02/2024
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Provider Practice Location Address
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Address Line | 1410 MCFARLAND BLVD N
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City | TUSCALOOSA
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State | AL
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Zip | 35406-2459
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Country | US
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Telephone | 205-345-8208
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Fax |
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Provider Business Mailing Address
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Address Line | 8203 N LAGOON DR
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City | PANAMA CITY
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State | FL
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Zip | 32408-5267
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Country | US
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Telephone | 850-896-0773
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Fax | 850-234-9272
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | MD.11479
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | ME40682
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License Number State | FL
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