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General NPI Number Information
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NPI Number | 1831483767
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Entity Type | Organization
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Legal Business Name | TAHOE ORTHOPEDICS AND SPORTS MEDICINE, INC
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Dates
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Enumeration Date | 06/08/2011
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Last Update Date | 04/17/2020
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Provider Practice Location Address
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Address Line | 1139 3RD ST
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City | SOUTH LAKE TAHOE
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State | CA
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Zip | 96150-3465
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Country | US
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Telephone | 530-541-3100
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Fax |
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Provider Business Mailing Address
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Address Line | 1111 EMERALD BAY RD
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City | SOUTH LAKE TAHOE
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State | CA
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Zip | 96150-6207
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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 | PRESIDENT
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Name | DR. ROBERT E. RUPP
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Credential | MD
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Telephone | 530-541-3100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | G82106
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License Number State | CA
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