Individual
MR. PATRICK LEE WUPPERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8101 S BROADWAY AVE, SUITE 200, TYLER, TX 75703-5469
(903) 939-7500
(903) 939-7728
Mailing address
PO BOX 130189, TYLER, TX 75713-0189
(903) 939-7500
(903) 939-7728
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
M4666
TX
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
M4666
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
183593601
—
TX
Enumeration date
08/23/2006
Last updated
10/27/2022
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