# DR. JEFFREY BRUCE PUPP

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1497723324
- **Gender:** Man
- **Credential:** D.P.M.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213EP1101X | Primary Podiatric Medicine Podiatrist | 230 | NC | — |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | 230 | NC | Yes |
| 213ES0131X | Foot Surgery Podiatrist | 230 | NC | — |

## Other

- **Enumeration date:** 03/08/2006
- **Last updated:** 09/18/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0809N | BCBS NC | NC |
| 05 | — | 890809N | — | NC |
| 01 | — | E1549 | MEDCOST | NC |
| 01 | — | E1551 | MEDCOST | NC |
| 01 | — | P00959571 | MEDICARE RAILROAD | NC |