=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265798912
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RUTHPRO INCORPORATED
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/06/2012
-----------------------------------------------------
Last Update Date | 06/20/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5300 W HILLSBORO BLVD SUITE 103
-----------------------------------------------------
City | COCONUT CREEK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33073-4395
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-570-4011
-----------------------------------------------------
Fax | 954-570-6728
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16306 BRAEBURN RIDGE TRL
-----------------------------------------------------
City | DELRAY BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33446-9508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-638-1778
-----------------------------------------------------
Fax | 954-570-6728
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SHAREHOLDER/OWNER
-----------------------------------------------------
Name | DR. MICHAEL S. PROPPER
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 954-570-4011
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207XX0801X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Trauma Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------