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General NPI Number Information
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NPI Number | 1568414985
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Entity Type | Individual
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Provider Name | MICHAEL RICHARD RUPP MD
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Gender | Male
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Dates
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Enumeration Date | 05/16/2006
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Last Update Date | 01/30/2019
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Provider Practice Location Address
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Address Line | 3800 E LOHMAN AVE STE A
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City | LAS CRUCES
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State | NM
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Zip | 88011-8287
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Country | US
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Telephone | 575-522-6500
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Fax | 575-522-0591
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Provider Business Mailing Address
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Address Line | 3800 E LOHMAN AVE STE A
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City | LAS CRUCES
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State | NM
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Zip | 88011-8287
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Country | US
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Telephone | 575-522-6500
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Fax | 575-522-0591
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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 | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | MD2006-0458
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 207KA0200X
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Taxonomy Name | Allergy Physician
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License Number | MD2006-0458
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License Number State | NM
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