Provider Demographics
NPI:1235990078
Name:CUPPAWHE, ALEX B
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:B
Last Name:CUPPAWHE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 E 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-3817
Mailing Address - Country:US
Mailing Address - Phone:405-747-6578
Mailing Address - Fax:
Practice Address - Street 1:1203 E 5TH AVE
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-3817
Practice Address - Country:US
Practice Address - Phone:405-747-6578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist