MEDICARE: DR. STEVEN J BUPP M.D.

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	2084P0800X	Psychiatry Physician	19350	KS

General Provider Information

NPI Number	:	1780659029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN J BUPP M.D.

Provider Business Mailing Address
First Line	:	5160 E GLENN ST # 100
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-1337
Country	:	US
Telephone Number	:	520-747-8494
Fax Number	:	520-748-2609

Provider Business Practice Location Address
First Line	:	5160 E GLENN ST # 100
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-1337
Country	:	US
Telephone Number	:	520-747-8494
Fax Number	:	520-748-2609

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

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	08/22/2011

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