MEDICARE: MARK KUPER DO PA

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	208VP0014X	Interventional Pain Medicine Physician	L7789	TX
3	2084P2900X	Pain Medicine (Psychiatry & Neurology) Physician	L7789	TX
4	207XS0117X	Orthopaedic Surgery of the Spine Physician	L7789	TX

General Provider Information

NPI Number	:	1578727988
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARK KUPER DO PA

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	:	DO
Name	:	MARK KUPER
Credential	:	DO
Telephone Number	:	817-735-9397

Provider Enumeration Date	:	07/15/2008
Last Update Date	:	12/04/2015

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