Provider Demographics
NPI:1447200464
Name:MAKAPUGAY, FIDEL DELEON
Entity Type:Individual
Prefix:DR
First Name:FIDEL
Middle Name:DELEON
Last Name:MAKAPUGAY
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 1:491 W POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-2537
Mailing Address - Country:US
Mailing Address - Phone:901-850-9900
Mailing Address - Fax:901-853-2706
Practice Address - Street 1:491 W POPLAR AVE
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-2537
Practice Address - Country:US
Practice Address - Phone:901-850-9900
Practice Address - Fax:901-853-2706
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000021004207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3121215OtherBCBST-TN
TN3057248Medicare ID - Type UnspecifiedMEDICARE