Provider Demographics
NPI:1861019739
Name:DUPREE, THOMAS R JR
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:R
Last Name:DUPREE
Suffix:JR
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 1:321 BROOKS
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:TX
Mailing Address - Zip Code:75657-4443
Mailing Address - Country:US
Mailing Address - Phone:903-930-3934
Mailing Address - Fax:
Practice Address - Street 1:321 BROOKS
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:TX
Practice Address - Zip Code:75657-4443
Practice Address - Country:US
Practice Address - Phone:903-930-3934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-26
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP146121363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily