MEDICARE: DR. MARK P KUPER D.O.

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	207X00000X	Orthopaedic Surgery Physician	L7789	TX
2	207XS0117X	Orthopaedic Surgery of the Spine Physician	L7789	TX

General Provider Information

NPI Number	:	1013069780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK P KUPER D.O.

Provider Business Mailing Address
First Line	:	6251 OAKMONT BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-3119
Country	:	US
Telephone Number	:	817-735-9397
Fax Number	:	817-735-8340

Provider Business Practice Location Address
First Line	:	6251 OAKMONT BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-3119
Country	:	US
Telephone Number	:	817-735-9397
Fax Number	:	817-735-8340

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

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	12/02/2015

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