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General NPI Number Information
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NPI Number | 1558360628
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Entity Type | Individual
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Provider Name | ROBERT EDWARD RUPP MD
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Gender | Male
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Dates
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Enumeration Date | 07/20/2005
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Last Update Date | 07/16/2025
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Provider Practice Location Address
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Address Line | 165 HIGHWAY 50
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City | STATELINE
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State | NV
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Zip | 89449-9816
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Country | US
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Telephone | 775-589-8950
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Fax | 775-588-1299
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Provider Business Mailing Address
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Address Line | 2170 SOUTH AVE
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City | SOUTH LAKE TAHOE
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State | CA
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Zip | 96150-7026
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Country | US
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Telephone | 530-543-5659
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Fax | 530-541-8723
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | A67307
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 8856
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License Number State | NV
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