Provider Demographics
NPI:1376576769
Name:KLEPPER, MARK STUART (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:STUART
Last Name:KLEPPER
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:PO BOX 20308
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76702-0308
Mailing Address - Country:US
Mailing Address - Phone:254-537-6868
Mailing Address - Fax:254-537-6869
Practice Address - Street 1:318 RICHLAND WEST CIR
Practice Address - Street 2:SUITE A
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-7919
Practice Address - Country:US
Practice Address - Phone:254-537-6600
Practice Address - Fax:254-537-6601
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2510207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137496911Medicaid
TX8AV861OtherBCBS TX
TXE22366Medicare UPIN
TX8AV861OtherBCBS TX
TX8L2598Medicare PIN