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Individual

SANDRA H. PUPA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
1730A 14TH ST, MERIDIAN, MS 39301-4140
(601) 703-4395
(601) 703-4394
Mailing address
PO BOX 908, MERIDIAN, MS 39302-0908
(601) 703-4282
(601) 703-4597

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
13753
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00115892
MS
05
009601090
AL
01
300074586
RAILROAD MEDICARE
01
730-74365
BLUE CROSS OF AL
Enumeration date
07/12/2005
Last updated
11/09/2013
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