Provider Demographics
NPI:1457028904
Name:ERIC R. TEPPER, DPM
Entity Type:Organization
Organization Name:ERIC R. TEPPER, DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:R
Authorized Official - Last Name:TEPPER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:281-980-3668
Mailing Address - Street 1:3143 HIGHWAY 6
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-4367
Mailing Address - Country:US
Mailing Address - Phone:281-980-3668
Mailing Address - Fax:281-980-1124
Practice Address - Street 1:3143 HIGHWAY 6
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4367
Practice Address - Country:US
Practice Address - Phone:281-980-3668
Practice Address - Fax:281-980-1124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX018800501Medicaid