Provider Demographics
NPI:1790933240
Name:LARY R. KUPOR MD PA
Entity Type:Organization
Organization Name:LARY R. KUPOR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LARY
Authorized Official - Middle Name:R
Authorized Official - Last Name:KUPOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:979-282-9955
Mailing Address - Street 1:1315 ST JOSEPH PKWY STE 1106
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-8235
Mailing Address - Country:US
Mailing Address - Phone:713-951-0421
Mailing Address - Fax:713-652-2717
Practice Address - Street 1:1315 ST JOSEPH PKWY STE 1106
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-8235
Practice Address - Country:US
Practice Address - Phone:713-951-0421
Practice Address - Fax:713-652-2717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-08
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE3036207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty