1962490375 NPI number — MR. EDWARD R. DUPAY JR. D.O.

Table of content: MR. EDWARD R. DUPAY JR. D.O. (NPI 1962490375)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962490375 NPI number — MR. EDWARD R. DUPAY JR. D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUPAY
Provider First Name:
EDWARD
Provider Middle Name:
R.
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962490375
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/25/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3033 WINKLER AVENUE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
FORT MYERS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33916
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-277-7070
Provider Business Mailing Address Fax Number:
239-277-7071

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3033 WINKLER AVENUE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
FORT MYERS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33916
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-277-7070
Provider Business Practice Location Address Fax Number:
239-277-7071
Provider Enumeration Date:
10/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  OS4788 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0905249 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 80519 . This is a "BCBS & MEDICARE GROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 15743 . This is a "STAYWELL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 275660900 . This is a "MEDICIAD GROUP NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 046335300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 650075827 . This is a "TAX ID FOR GROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1806973002 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 82973 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 071682 . This is a "AETNA NON HMO" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1003858 . This is a "PHP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 201702 . This is a "AMERIGROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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