Provider Demographics
NPI:1952346389
Name:KUPOR, LARY (MD)
Entity Type:Individual
Prefix:DR
First Name:LARY
Middle Name:
Last Name:KUPOR
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 1:1315 ST JOSEPH PKWY
Mailing Address - Street 2:STE 1709
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-8233
Mailing Address - Country:US
Mailing Address - Phone:713-951-0421
Mailing Address - Fax:713-951-0711
Practice Address - Street 1:1315 ST JOSEPH PKWY
Practice Address - Street 2:STE 1709
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-8233
Practice Address - Country:US
Practice Address - Phone:713-951-0421
Practice Address - Fax:713-951-0711
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE3036207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00CA78Medicare ID - Type Unspecified
TXB3036Medicare UPIN