Provider Demographics
NPI:1386623429
Name:DOUPNIK, LADISLAV (MD)
Entity type:Individual
Prefix:DR
First Name:LADISLAV
Middle Name:
Last Name:DOUPNIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:TX
Mailing Address - Zip Code:78382-3333
Mailing Address - Country:US
Mailing Address - Phone:361-729-0646
Mailing Address - Fax:361-729-8851
Practice Address - Street 1:1325 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:TX
Practice Address - Zip Code:78382-3333
Practice Address - Country:US
Practice Address - Phone:361-729-0646
Practice Address - Fax:361-729-8851
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF1512207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB62726Medicare UPIN