Provider Demographics
NPI:1619965878
Name:DUPONT, CEDRIC (MD)
Entity Type:Individual
Prefix:DR
First Name:CEDRIC
Middle Name:
Last Name:DUPONT
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 1:807 PEDEN ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-1336
Mailing Address - Country:US
Mailing Address - Phone:713-529-0254
Mailing Address - Fax:713-529-2496
Practice Address - Street 1:6431 FANNIN ST
Practice Address - Street 2:MSB 5.020
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1501
Practice Address - Country:US
Practice Address - Phone:713-500-6222
Practice Address - Fax:713-500-6270
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5320207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K2218OtherBCBSTX
TXI30844Medicare UPIN
TX8D5843Medicare ID - Type Unspecified