Provider Demographics
NPI:1144365487
Name:KRUPPSTADT, PAULA JEAN (MD)
Entity type:Individual
Prefix:DR
First Name:PAULA
Middle Name:JEAN
Last Name:KRUPPSTADT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PAULA
Other - Middle Name:JEAN
Other - Last Name:LOCKHART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:150 PINE FOREST DR STE 701
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77384-5317
Mailing Address - Country:US
Mailing Address - Phone:281-725-6767
Mailing Address - Fax:888-886-9009
Practice Address - Street 1:150 PINE FOREST DR STE 701
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77384-5317
Practice Address - Country:US
Practice Address - Phone:281-725-6767
Practice Address - Fax:888-886-9009
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2019-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1104208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics