Provider Demographics
NPI:1689876922
Name:DUPRE, JOSEPH DEAN
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:DEAN
Last Name:DUPRE
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 1:12919 FM 2276 N
Mailing Address - Street 2:
Mailing Address - City:KILGORE
Mailing Address - State:TX
Mailing Address - Zip Code:75662-7237
Mailing Address - Country:US
Mailing Address - Phone:903-984-1706
Mailing Address - Fax:
Practice Address - Street 1:12919 FM 2276 N
Practice Address - Street 2:
Practice Address - City:KILGORE
Practice Address - State:TX
Practice Address - Zip Code:75662-7237
Practice Address - Country:US
Practice Address - Phone:903-984-1706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21468183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist