Provider Demographics
NPI:1972782159
Name:JUOPPERI, THOMAS DOUGLASS (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:DOUGLASS
Last Name:JUOPPERI
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2521
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27715-2521
Mailing Address - Country:US
Mailing Address - Phone:719-244-4619
Mailing Address - Fax:
Practice Address - Street 1:104 HUFFMAN MILL RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-5113
Practice Address - Country:US
Practice Address - Phone:336-506-1720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-24
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3887363A00000X
NYP61378363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical