Provider Demographics
NPI:1831161793
Name:DUPONT, ELISABETH LYNN (MD)
Entity type:Individual
Prefix:
First Name:ELISABETH
Middle Name:LYNN
Last Name:DUPONT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 LAKELAND HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-3019
Mailing Address - Country:US
Mailing Address - Phone:863-680-7000
Mailing Address - Fax:866-264-8519
Practice Address - Street 1:1420 LAKELAND HILLS BLVD
Practice Address - Street 2:WOMEN'S CENTER BLDG B
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-3202
Practice Address - Country:US
Practice Address - Phone:863-680-7486
Practice Address - Fax:866-264-8519
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76168208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254708200Medicaid
G72907Medicare UPIN
FL43993ZMedicare PIN