Provider Demographics
NPI:1477531978
Name:SUPKAY, VERONICA A (MD)
Entity Type:Individual
Prefix:DR
First Name:VERONICA
Middle Name:A
Last Name:SUPKAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7200 WYOMING SPRINGS DR
Mailing Address - Street 2:SUITE 1500
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-4303
Mailing Address - Country:US
Mailing Address - Phone:512-218-8696
Mailing Address - Fax:512-218-9532
Practice Address - Street 1:7200 WYOMING SPRINGS DR
Practice Address - Street 2:SUITE 1500
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4303
Practice Address - Country:US
Practice Address - Phone:512-218-8696
Practice Address - Fax:512-218-9532
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD24121207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR286585Medicaid
OR286585Medicaid
OR113701Medicare ID - Type Unspecified