Provider Demographics
NPI:1023184017
Name:DUPPER, KATHLEEN M (MD)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:M
Last Name:DUPPER
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:2422 DANVILLE RD SW
Mailing Address - Street 2:SUITE C
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35603-4220
Mailing Address - Country:US
Mailing Address - Phone:256-340-1500
Mailing Address - Fax:256-340-1566
Practice Address - Street 1:2422 DANVILLE RD SW
Practice Address - Street 2:SUITE C
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603-4220
Practice Address - Country:US
Practice Address - Phone:256-340-1500
Practice Address - Fax:256-340-1566
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL20222207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H11594Medicare UPIN
AL051519618DUPMedicare ID - Type Unspecified