Provider Demographics
NPI:1104810738
Name:KUPPERMAN, JEFFREY LEON (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:LEON
Last Name:KUPPERMAN
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:PO BOX 50706
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93150-0706
Mailing Address - Country:US
Mailing Address - Phone:805-963-3757
Mailing Address - Fax:805-564-3332
Practice Address - Street 1:2428 CASTILLO ST
Practice Address - Street 2:SUITE D
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105
Practice Address - Country:US
Practice Address - Phone:805-845-1500
Practice Address - Fax:805-845-0333
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG34672207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA290011938OtherRAILROAD MEDICARE
CA00G346720Medicaid
CA00G346720Medicaid
CAG34672Medicare PIN