Basic Information
| Provider Information | |||||||||
| NPI: | 1124019591 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAPPER | ||||||||
| FirstName: | EDWARD | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 973 MICA DR | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | CARSON CITY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 897057255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7757836190 | ||||||||
| FaxNumber: | 7757836191 | ||||||||
| Practice Location | |||||||||
| Address1: | 1520 VIRGINIA RANCH RD | ||||||||
| Address2: | SUITE 101B | ||||||||
| City: | GARDNERVILLE | ||||||||
| State: | NV | ||||||||
| PostalCode: | 894105731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7757822442 | ||||||||
| FaxNumber: | 7757836199 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2005 | ||||||||
| LastUpdateDate: | 10/04/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | C29083 | CA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 3279 | NV | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 00C290830 | 01 | CA | MEDI-CAL | OTHER | CC6621 | 01 | NV | BCBS | OTHER | 2003061 | 05 | NV | MEDICAID | P00722837 | 01 | NV | MEDICARE RAILROAD | OTHER |