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General NPI Number Information
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NPI Number | 1972622363
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Entity Type | Organization
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Legal Business Name | RON RUPPERT PC
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 10/11/2007
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Provider Practice Location Address
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Address Line | 4275 BURNHAM AVE SUITE 365
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City | LAS VEGAS
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State | NV
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Zip | 89119-8207
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Country | US
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Telephone | 702-731-1105
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Fax | 702-731-1201
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Provider Business Mailing Address
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Address Line | 4275 BURNHAM AVE SUITE 365
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City | LAS VEGAS
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State | NV
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Zip | 89119-8207
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Country | US
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Telephone | 702-731-1105
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Fax | 702-731-1201
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RONALD C RUPPERT
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Credential | D.O.
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Telephone | 702-731-1105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DO488
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License Number State | NV
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