# JEFFREY B PUPP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Wallace Foot Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1275709677
- **Authorized official:** DR. JEFFREY B PUPP (OWNER)
- **Authorized official phone:** (910) 285-3362

## Contact information

- **Practice address:** 114 N NORWOOD ST, WALLACE, NC 28466-2730
- **Practice address phone:** (910) 285-3362
- **Practice address fax:** (910) 285-6683
- **Mailing address:** 114 N NORWOOD ST, WALLACE, NC 28466-2730
- **Mailing address phone:** (910) 285-3362
- **Mailing address fax:** (910) 285-6683

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | 449 | NC | Yes |
| 213ES0131X | Foot Surgery Podiatrist | 230 | NC | — |

## Other

- **Enumeration date:** 05/06/2008
- **Last updated:** 05/06/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0152P | BCBS NC | NC |
| 01 | — | 2432650A | MEDICARE PTAN | NC |
| 05 | — | 890152P | — | NC |
| 01 | — | B1114 | MEDCOST | NC |
| 01 | — | CJ7762 | RAILROAD MEDICARE PTAN | NC |