=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699706465
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RONALD KAPUSTA MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/06/2006
-----------------------------------------------------
Last Update Date | 09/06/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3012 E HEBRON PARKWAY STE 104
-----------------------------------------------------
City | CARROLLTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75010-4428
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-394-0200
-----------------------------------------------------
Fax | 972-492-3390
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3012 E HEBRON PARKWAY STE 104
-----------------------------------------------------
City | CARROLLTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75010-4428
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-394-0200
-----------------------------------------------------
Fax | 972-492-3390
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | E8015
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------