Organization
JEFFREY B. PUPP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY B PUPP (OWNER)
(910) 343-8889
Entity
Organization
Contact information
Practice address
1602 DOCTORS CIR, WILMINGTON, NC 28401-7406
(910) 343-8889
(910) 343-9990
Mailing address
1602 DOCTORS CIR, WILMINGTON, NC 28401-7406
(910) 343-8889
(910) 343-9990
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
—
0231R
BCBS NC
NC
01
—
2432650
MEDICARE PTAN
NC
05
—
890231R
—
NC
01
—
B1115
MEDCOST
NC
01
—
CC3025
RAILROAD MEDICARE PTAN
NC
Enumeration date
08/07/2006
Last updated
11/05/2007
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