Provider Demographics
NPI:1831496090
Name:J ERIC STUPKA MD PA
Entity Type:Organization
Organization Name:J ERIC STUPKA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:STUPKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-655-6400
Mailing Address - Street 1:12709 TOEPPERWEIN RD
Mailing Address - Street 2:201
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-3258
Mailing Address - Country:US
Mailing Address - Phone:210-655-6400
Mailing Address - Fax:210-655-6404
Practice Address - Street 1:12709 TOEPPERWEIN RD
Practice Address - Street 2:201
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3258
Practice Address - Country:US
Practice Address - Phone:210-655-6400
Practice Address - Fax:210-655-6404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-23
Last Update Date:2011-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty