Provider Demographics
NPI:1457373714
Name:WIPRUD, JOHN M (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:WIPRUD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6435 S FM 549
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HEATH
Mailing Address - State:TX
Mailing Address - Zip Code:75032-6220
Mailing Address - Country:US
Mailing Address - Phone:972-771-9155
Mailing Address - Fax:972-771-2390
Practice Address - Street 1:6435 S FM 549
Practice Address - Street 2:SUITE 201
Practice Address - City:HEATH
Practice Address - State:TX
Practice Address - Zip Code:75032-6220
Practice Address - Country:US
Practice Address - Phone:972-771-9155
Practice Address - Fax:972-771-2390
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2022-11-14
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Provider Licenses
StateLicense IDTaxonomies
TXK6415207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX102029904Medicaid
TX102029903Medicaid
TX308794YT5NMedicare PIN
TXP00028710Medicare PIN
TX102029904Medicaid
TX102029903Medicaid