Provider Demographics
NPI:1780850826
Name:DUPPER, MATTHEW ERICH
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ERICH
Last Name:DUPPER
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 1:6969 BROCKTON AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-3833
Mailing Address - Country:US
Mailing Address - Phone:951-686-3575
Mailing Address - Fax:951-781-2194
Practice Address - Street 1:6969 BROCKTON AVE
Practice Address - Street 2:SUITE B
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-3833
Practice Address - Country:US
Practice Address - Phone:951-686-3575
Practice Address - Fax:951-781-2194
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA109453207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1780850826Medicaid
CA1780850826Medicaid