Provider Demographics
NPI:1851500185
Name:DUPRE, JAYSON M (DO)
Entity type:Individual
Prefix:DR
First Name:JAYSON
Middle Name:M
Last Name:DUPRE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 LAKEVIEW CT
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-1541
Mailing Address - Country:US
Mailing Address - Phone:610-393-1221
Mailing Address - Fax:
Practice Address - Street 1:703 LAKEVIEW CT
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-1541
Practice Address - Country:US
Practice Address - Phone:610-393-1221
Practice Address - Fax:610-222-7114
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS010880L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine