Provider Demographics
NPI:1578727988
Name:MARK KUPER DO PA
Entity Type:Organization
Organization Name:MARK KUPER DO PA
Other - Org Name:MARK KUPER DO
Other - Org Type:Other Name
Authorized Official - Title/Position:DO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:KUPER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-735-9397
Mailing Address - Street 1:6251 OAKMONT BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-3119
Mailing Address - Country:US
Mailing Address - Phone:817-735-9397
Mailing Address - Fax:817-735-8340
Practice Address - Street 1:6251 OAKMONT BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-3119
Practice Address - Country:US
Practice Address - Phone:817-735-9397
Practice Address - Fax:817-735-8340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-15
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7789207X00000X, 207XS0117X, 2084P2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Z480Medicare PIN
TXI20936Medicare UPIN