Provider Demographics
NPI:1366648503
Name:ROBERT L DUPPER M.D. P.C.
Entity Type:Organization
Organization Name:ROBERT L DUPPER M.D. P.C.
Other - Org Name:VEIN TREATMENT SPECIALISTS P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:DUPPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-776-1600
Mailing Address - Street 1:272 E 29TH ST
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538
Mailing Address - Country:US
Mailing Address - Phone:970-776-1600
Mailing Address - Fax:970-776-1606
Practice Address - Street 1:272 E 29TH ST
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538
Practice Address - Country:US
Practice Address - Phone:970-776-1600
Practice Address - Fax:970-776-1606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO35872202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO06724710Medicaid