Provider Demographics
NPI:1821231929
Name:TUPPER ORTHOPEDICS PLLC
Entity Type:Organization
Organization Name:TUPPER ORTHOPEDICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:GENENE
Authorized Official - Last Name:TUPPER
Authorized Official - Suffix:
Authorized Official - Credentials:RN/OPA-C
Authorized Official - Phone:405-757-8338
Mailing Address - Street 1:12301 N WESTERN AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-8017
Mailing Address - Country:US
Mailing Address - Phone:405-757-8338
Mailing Address - Fax:405-757-9294
Practice Address - Street 1:12301 N WESTERN AVE STE 101
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-8017
Practice Address - Country:US
Practice Address - Phone:405-757-8338
Practice Address - Fax:405-715-7179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-20
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK17397207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKOKB5561Medicare PIN