Individual
GARY WILLIAM DUPRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2600 FERRY ST, LAFAYETTE, IN 47904-3055
(765) 448-8000
(765) 838-4698
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01033752A
IN
208M00000X
Hospitalist Physician
Primary
01033752A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000192362
ANTHEM PROVIDER NUMBER
IN
05
—
100206900
—
IN
01
—
11484453
CAQH NUMBER
IN
01
—
9397021
PHCS PID NUMBER
IN
05
—
DU64948011
—
IN
Enumeration date
03/16/2006
Last updated
01/25/2021
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