Provider Demographics
NPI:1760466593
Name:TUPAC, LUIS A (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:A
Last Name:TUPAC
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Gender:M
Credentials:MD
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Mailing Address - Street 1:3006 S MARYLAND PARKWAY
Mailing Address - Street 2:520
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109
Mailing Address - Country:US
Mailing Address - Phone:702-733-2998
Mailing Address - Fax:702-733-9741
Practice Address - Street 1:3006 S MARYLAND PARKWAY
Practice Address - Street 2:520
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-2244
Practice Address - Country:US
Practice Address - Phone:702-733-2998
Practice Address - Fax:702-733-9741
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-05
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NV3129207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C96804Medicare UPIN