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General NPI Number Information
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NPI Number | 1003043928
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Entity Type | Individual
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Provider Name | SUPRINA DORAI M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/18/2009
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Last Update Date | 11/22/2022
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Provider Practice Location Address
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Address Line | 8721 MENCHACA RD
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City | AUSTIN
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State | TX
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Zip | 78748-5308
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Country | US
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Telephone | 512-280-6959
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Fax |
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Provider Business Mailing Address
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Address Line | 7911 EL DORADO DR
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City | AUSTIN
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State | TX
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Zip | 78737-3010
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Country | US
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Telephone | 917-453-5021
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | Q6315
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License Number State | TX
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