Provider Demographics
NPI:1053359299
Name:KRUPKIN, ROBERT HARRIS (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:HARRIS
Last Name:KRUPKIN
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:PO BOX 380
Mailing Address - Street 2:
Mailing Address - City:BUNKIE
Mailing Address - State:LA
Mailing Address - Zip Code:71322
Mailing Address - Country:US
Mailing Address - Phone:318-346-3339
Mailing Address - Fax:
Practice Address - Street 1:427 EVERGREEN HWY.
Practice Address - Street 2:
Practice Address - City:BUNKIE
Practice Address - State:LA
Practice Address - Zip Code:71322-0380
Practice Address - Country:US
Practice Address - Phone:318-346-3339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA06118R208600000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA06118ROtherSTATE LICENSE
LA1344761Medicaid
LA53245Medicare ID - Type Unspecified
LA06118ROtherSTATE LICENSE