Provider Demographics
NPI:1578651089
Name:TUPPONCE, ALAN K (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:K
Last Name:TUPPONCE
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 1:7864 RICHMOND TAPPAHANNOCK HWY
Mailing Address - Street 2:
Mailing Address - City:AYLETT
Mailing Address - State:VA
Mailing Address - Zip Code:23009-3056
Mailing Address - Country:US
Mailing Address - Phone:804-535-0145
Mailing Address - Fax:602-263-1637
Practice Address - Street 1:7864 RICHMOND TAPPAHANNOCK HWY
Practice Address - Street 2:
Practice Address - City:AYLETT
Practice Address - State:VA
Practice Address - Zip Code:23009-3056
Practice Address - Country:US
Practice Address - Phone:804-535-0145
Practice Address - Fax:602-263-1637
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101270925207Q00000X
OK21275208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA3001529971Medicaid
AZAZ0713440OtherBCBS
AZAZ0713440OtherBCBS
8HZ92E PART BMedicare ID - Type Unspecified
H45193Medicare UPIN