MEDICARE: RONALD B KUPPERSMITH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207YX0007X	Plastic Surgery within the Head & Neck (Otolaryngology) Physician	L5799	TX
2	207YX0602X	Otolaryngic Allergy Physician	L5799	TX
3	207Y00000X	Otolaryngology Physician	L5799	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	X0127267	OTHER	TX	DPS

General Provider Information

NPI Number	:	1013959287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD B KUPPERSMITH M.D.

Provider Business Mailing Address
First Line	:	PO BOX 10194
Second Line	:
City	:	COLLEGE STATION
State	:	TX
Zip	:	77842-0194
Country	:	US
Telephone Number	:	979-693-6000
Fax Number	:	979-693-1900

Provider Business Practice Location Address
First Line	:	1730 BIRMINGHAM DR
Second Line	:
City	:	COLLEGE STATION
State	:	TX
Zip	:	77845-4063
Country	:	US
Telephone Number	:	979-693-6000
Fax Number	:	979-693-1900

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	03/07/2023

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Directions to “ RONALD B KUPPERSMITH M.D.” Practice Location

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