MEDICARE: MARK J HUPERT 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	207RI0200X	Infectious Disease Physician	L1619	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00289085	OTHER		MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	8J8302	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1265407761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK J HUPERT M.D.

Provider Business Mailing Address
First Line	:	1125 COLLEGE AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4514
Country	:	US
Telephone Number	:	817-348-0821
Fax Number	:	817-348-0073

Provider Business Practice Location Address
First Line	:	1124 COLLEGE AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4557
Country	:	US
Telephone Number	:	817-348-0821
Fax Number	:	817-348-0073

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

Provider Enumeration Date	:	02/20/2006
Last Update Date	:	01/21/2013

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Directions to “ MARK J HUPERT M.D.” Practice Location

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