Provider Demographics
NPI:1982695581
Name:DUPPSTADT, EDWIN ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:ROBERT
Last Name:DUPPSTADT
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 1:3223 OMEGA DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76014-2006
Mailing Address - Country:US
Mailing Address - Phone:817-465-7661
Mailing Address - Fax:817-465-7679
Practice Address - Street 1:3223 OMEGA DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014-2006
Practice Address - Country:US
Practice Address - Phone:817-465-7661
Practice Address - Fax:817-465-7679
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7722207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH77882Medicare UPIN
TX00510HMedicare PIN