Provider Demographics
NPI:1932147196
Name:STROUPE, EARNEST W (MD)
Entity Type:Individual
Prefix:
First Name:EARNEST
Middle Name:W
Last Name:STROUPE
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:PO BOX 841656
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-1656
Mailing Address - Country:US
Mailing Address - Phone:903-531-5000
Mailing Address - Fax:
Practice Address - Street 1:800 E DAWSON ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2036
Practice Address - Country:US
Practice Address - Phone:903-593-8441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3947207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0044EJOtherBCBS
TX75-2616977-001OtherTRICARE
TX75-2616977-002OtherTRICARE
TX75-0818167-048OtherTRICARE
TXP01464118OtherRAIL ROAD MEDICARE
TX39715YNSXOtherMEDICARE
TX75-0818167-022OtherTRICARE
TX030151701Medicaid
TX139345622Medicaid
TX8BL713OtherBCBS
TX8EY984OtherBCBS
TX75-2616977-028OtherTRICARE
TX8EY984OtherBCBS
TX75-0818167-022OtherTRICARE
TX030151701Medicaid
TX930089204Medicare PIN