=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154308443
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN-PAUL RUE M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/28/2005
-----------------------------------------------------
Last Update Date | 07/10/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 301 SAINT PAUL PL
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21202-2165
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-412-2363
-----------------------------------------------------
Fax | 410-760-2909
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 301 SAINT PAUL PL
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21202-2165
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-412-2363
-----------------------------------------------------
Fax | 410-760-2909
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | D00058956
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------