Provider Demographics
NPI:1184618696
Name:KUPERMAN, DOUGLAS ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:ALAN
Last Name:KUPERMAN
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 1:2089 HAWTHORNE ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2308
Mailing Address - Country:US
Mailing Address - Phone:941-365-6556
Mailing Address - Fax:941-365-6678
Practice Address - Street 1:2089 HAWTHORNE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2308
Practice Address - Country:US
Practice Address - Phone:941-365-6556
Practice Address - Fax:941-365-6678
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME43099207RG0100X, 207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME43099OtherME#
FLME43099OtherME#
07011XMedicare Oscar/Certification
FL07011ZMedicare ID - Type Unspecified
FLME43099OtherME#