Healthcare Provider Details

I. General information

NPI: 1952346389
Provider Name (Legal Business Name): LARY KUPOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 10/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 ST JOSEPH PKWY STE 1709
HOUSTON TX
77002-8233
US

IV. Provider business mailing address

1315 ST JOSEPH PKWY STE 1709
HOUSTON TX
77002-8233
US

V. Phone/Fax

Practice location:
  • Phone: 713-951-0421
  • Fax: 713-951-0711
Mailing address:
  • Phone: 713-951-0421
  • Fax: 713-951-0711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberE3036
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: