Provider Demographics
NPI:1285832964
Name:KUPFNER, JOHN GREGORY (MD)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:GREGORY
Last Name:KUPFNER
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 1:9709 STONE HENGE LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-3447
Mailing Address - Country:US
Mailing Address - Phone:865-258-6134
Mailing Address - Fax:865-258-6134
Practice Address - Street 1:3889 WONDERLAND LN
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-8288
Practice Address - Country:US
Practice Address - Phone:865-366-7812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43015123912084P0800X
VA01012414642084P0800X
TN460262084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1521350Medicaid
TN1521350Medicaid