Provider Demographics
NPI:1922118298
Name:DUPONT, JASON PAUL (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:PAUL
Last Name:DUPONT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6296 E GRANT RD STE 180
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-5832
Mailing Address - Country:US
Mailing Address - Phone:520-290-8555
Mailing Address - Fax:520-290-6470
Practice Address - Street 1:6296 E GRANT RD STE 180
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-5832
Practice Address - Country:US
Practice Address - Phone:520-290-8555
Practice Address - Fax:520-290-6470
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31546207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP00424709OtherRAILROAD MEDICARE
AZP00424709OtherRAILROAD MEDICARE
AZ120644Medicare PIN
AZZ130598Medicare PIN
AZZ131413Medicare PIN