MEDICARE: DR. D'MICHELLE P DUPRE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZF0201X	Forensic Pathology Physician	1302	VI

General Provider Information

NPI Number	:	1295737047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. D'MICHELLE P DUPRE MD

Provider Business Mailing Address
First Line	:	PMB 341
Second Line	:	4098 DIAMOND RUBY #7
City	:	CHRISTIANSTED
State	:	VI
Zip	:	00820
Country	:	US
Telephone Number	:	340-778-6311
Fax Number	:	340-772-7386

Provider Business Practice Location Address
First Line	:	4007 ESTATE DIAMOND RUBY
Second Line	:	GOV. JUAN F. LUIS HOSPITAL
City	:	CHRISTIANSTED
State	:	VI
Zip	:	00820
Country	:	US
Telephone Number	:	340-778-6311
Fax Number	:	340-772-7386

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	07/08/2007

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