Basic Information
| Provider Information | |||||||||
| NPI: | 1972622363 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RON RUPPERT PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4275 BURNHAM AVE | ||||||||
| Address2: | SUITE 365 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891198207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7027311105 | ||||||||
| FaxNumber: | 7027311201 | ||||||||
| Practice Location | |||||||||
| Address1: | 4275 BURNHAM AVE | ||||||||
| Address2: | SUITE 365 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891198207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7027311105 | ||||||||
| FaxNumber: | 7027311201 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2007 | ||||||||
| LastUpdateDate: | 10/11/2007 | ||||||||
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| AuthorizedOfficialLastName: | RUPPERT | ||||||||
| AuthorizedOfficialFirstName: | RONALD | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7027311105 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | DO488 | NV | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.