Provider Demographics
NPI:1962517672
Name:TEXAS ENT & ALLERGY ASSOCIATES, LLP
Entity type:Organization
Organization Name:TEXAS ENT & ALLERGY ASSOCIATES, LLP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:B
Authorized Official - Last Name:KUPPERSMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:979-693-6000
Mailing Address - Street 1:PO BOX 10194
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77842-0194
Mailing Address - Country:US
Mailing Address - Phone:979-693-6000
Mailing Address - Fax:
Practice Address - Street 1:1730 BIRMINGHAM RD
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-4063
Practice Address - Country:US
Practice Address - Phone:979-693-6000
Practice Address - Fax:979-693-1900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX175007701Medicaid
TX0097MSOtherBLUE CROSS GROUP NUMBER