Provider Demographics
NPI:1932130986
Name:NOPHSKER, THEODORE ROBERT (DO)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:ROBERT
Last Name:NOPHSKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 AIRPORT FWY
Mailing Address - Street 2:SUITE 302
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-6605
Mailing Address - Country:US
Mailing Address - Phone:817-283-6995
Mailing Address - Fax:817-283-6901
Practice Address - Street 1:1305 AIRPORT FWY
Practice Address - Street 2:SUITE 302
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-6605
Practice Address - Country:US
Practice Address - Phone:817-283-6995
Practice Address - Fax:817-283-6901
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF8768207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1277196-03Medicaid
TX00SW44Medicare PIN
TXA67450Medicare UPIN