Provider Demographics
NPI:1508270059
Name:DUPOUX, MAX (LIC AP)
Entity Type:Individual
Prefix:
First Name:MAX
Middle Name:
Last Name:DUPOUX
Suffix:
Gender:M
Credentials:LIC AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 NE 40TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-3014
Mailing Address - Country:US
Mailing Address - Phone:954-404-2735
Mailing Address - Fax:
Practice Address - Street 1:4594 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33351-4515
Practice Address - Country:US
Practice Address - Phone:561-367-5008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-12
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2923171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist