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General NPI Number Information
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NPI Number | 1053535484
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Entity Type | Individual
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Provider Name | DANIEL EDWARD SUPKIS JR. MD
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Gender | Male
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Dates
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Enumeration Date | 04/13/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 4704 MONTROSE BLVD
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City | HOUSTON
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State | TX
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Zip | 77006-6122
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Country | US
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Telephone | 713-304-5353
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Fax |
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Provider Business Mailing Address
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Address Line | 303 TIMBER TERRACE RD
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City | HOUSTON
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State | TX
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Zip | 77024-5602
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Country | US
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Telephone | 713-304-5353
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Fax | 713-669-1671
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | G3831
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License Number State | TX
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