Provider Demographics
NPI:1528497948
Name:DUPRE, DERRICK ANDREW (MD)
Entity type:Individual
Prefix:
First Name:DERRICK
Middle Name:ANDREW
Last Name:DUPRE
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 1:8140 PICTON WAY STE 102
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-1782
Mailing Address - Country:US
Mailing Address - Phone:727-494-7573
Mailing Address - Fax:727-232-2820
Practice Address - Street 1:8140 PICTON WAY STE 102
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-1782
Practice Address - Country:US
Practice Address - Phone:727-494-7573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-06
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD451719207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
14250959OtherCAQH