Provider Demographics
NPI:1366901415
Name:DUPREE, JAKE WALSH (MD)
Entity type:Individual
Prefix:
First Name:JAKE
Middle Name:WALSH
Last Name:DUPREE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JAKE
Other - Middle Name:
Other - Last Name:WALSH-ARTEAGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:843-789-1620
Mailing Address - Fax:
Practice Address - Street 1:306 STATION 22 1/2 ST
Practice Address - Street 2:
Practice Address - City:SULLIVANS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29482-9756
Practice Address - Country:US
Practice Address - Phone:843-883-3176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-18
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC90697207Q00000X
390200000X
CAA176607207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program