Provider Demographics
NPI:1407054539
Name:JEFFERSON M TRUPP MD PC
Entity Type:Organization
Organization Name:JEFFERSON M TRUPP MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:S
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:256-236-5358
Mailing Address - Street 1:1320 LEIGHTON AVE STE A
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-4614
Mailing Address - Country:US
Mailing Address - Phone:256-236-5358
Mailing Address - Fax:256-236-3657
Practice Address - Street 1:1320 LEIGHTON AVE STE A
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-4614
Practice Address - Country:US
Practice Address - Phone:256-236-5358
Practice Address - Fax:256-236-3657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11479261QX0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC76316Medicare UPIN