Provider Demographics
NPI:1104872183
Name:LUPER, SCOTT D (ND)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:D
Last Name:LUPER
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
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Mailing Address - Street 1:104 KUTTER RD
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-3169
Mailing Address - Country:US
Mailing Address - Phone:907-452-3600
Mailing Address - Fax:907-452-3695
Practice Address - Street 1:104 KUTTER RD
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-3169
Practice Address - Country:US
Practice Address - Phone:907-452-3600
Practice Address - Fax:907-452-3695
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK30175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK30OtherSTATE NATUROPATH LICENSE