Provider Demographics
NPI:1184666299
Name:TEPPER, JAN DAVID (DPM)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:DAVID
Last Name:TEPPER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:984 W FOOTHILL BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3700
Mailing Address - Country:US
Mailing Address - Phone:909-920-0884
Mailing Address - Fax:909-920-9810
Practice Address - Street 1:984 W FOOTHILL BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3700
Practice Address - Country:US
Practice Address - Phone:909-920-0884
Practice Address - Fax:909-920-9810
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2154213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E21541Medicare UPIN