Provider Demographics
NPI:1760539647
Name:WUPPERMAN, RICHARD M (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:M
Last Name:WUPPERMAN
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 1:3000 N INTERSTATE 35 STE 708
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1860
Mailing Address - Country:US
Mailing Address - Phone:512-347-7463
Mailing Address - Fax:737-202-2561
Practice Address - Street 1:3000 N INTERSTATE 35 STE 708
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1860
Practice Address - Country:US
Practice Address - Phone:512-347-7463
Practice Address - Fax:737-202-2561
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8440207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00760229OtherMEDICARE RETIREMENT