Provider Demographics
NPI:1467543140
Name:CRUPIE, MARC J (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:J
Last Name:CRUPIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 4438
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38088-4438
Mailing Address - Country:US
Mailing Address - Phone:901-507-4400
Mailing Address - Fax:901-756-5836
Practice Address - Street 1:1025 CORDOVA STATION AVE
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-6318
Practice Address - Country:US
Practice Address - Phone:901-507-4400
Practice Address - Fax:901-756-5836
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000015815207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4064441OtherAETNA
TN3144579OtherBCBS OF TN
TN4064441OtherAETNA
TN3144579OtherBCBS OF TN