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Organization

JEFFREY B PUPP

Active
Other names
Wallace Foot Center
Organization subpart
No

Provider details

NPI number
Authorized official
DR. JEFFREY B PUPP (OWNER)
(910) 285-3362
Entity
Organization

Contact information

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

Taxonomy

Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
449
NC
213ES0131X
Foot Surgery Podiatrist
230
NC

Other

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
Enumeration date
05/06/2008
Last updated
05/06/2008
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