Individual
JIM ROY LUP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1021 MOREHEAD MEDICAL DR, SUITE A, CHARLOTTE, NC 28204-2990
(704) 355-2884
(704) 355-5800
Mailing address
PO BOX 602120, CHARLOTTE, NC 28260-2120
(704) 355-2884
(704) 355-5800
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-04274
NC
363A00000X
Physician Assistant
PA9102260
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1659PA
—
SC
05
—
1912125816
—
NC
05
—
291498100
—
FL
Enumeration date
04/23/2007
Last updated
03/20/2014
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