Provider Demographics
NPI:1558366914
Name:TUPA, CHRISTI M (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTI
Middle Name:M
Last Name:TUPA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6000 S STAPLES ST
Mailing Address - Street 2:SUITE 406
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-2952
Mailing Address - Country:US
Mailing Address - Phone:361-993-4835
Mailing Address - Fax:361-993-7043
Practice Address - Street 1:6000 S STAPLES ST
Practice Address - Street 2:SUITE 406
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-2952
Practice Address - Country:US
Practice Address - Phone:361-993-4835
Practice Address - Fax:361-993-7043
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2014-06-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXL4769208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0029JVOtherBLUE CROSS PROVIDER NUMER
TX00100267OtherCHIPS PROVIDER ID
TX154517002Medicaid
TX154517002Medicaid