Provider Demographics
NPI:1992708192
Name:DUPRE, ERNEST STEVE (MD)
Entity type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:STEVE
Last Name:DUPRE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ERNEST
Other - Middle Name:STEVE
Other - Last Name:DUPRE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2229 MARY SHERMAN DR
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:IN
Mailing Address - Zip Code:47882-7633
Mailing Address - Country:US
Mailing Address - Phone:812-268-3318
Mailing Address - Fax:812-268-4017
Practice Address - Street 1:2229 MARY SHERMAN DR
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:IN
Practice Address - Zip Code:47882-7633
Practice Address - Country:US
Practice Address - Phone:812-268-3318
Practice Address - Fax:812-268-4017
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01028949207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100105420BMedicaid
IN200015680AMedicaid
IN200015680AMedicaid
IN153868Medicare Oscar/Certification
IN100105420BMedicaid
INB28549Medicare UPIN