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NPI Code Detail

MEDICARE: MISTY RUPPERT MD

MEDICARE: MISTY RUPPERT MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207W00000XOphthalmology PhysicianU5501TX

General Provider Information

NPI Number : 1104440833
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISTY RUPPERT MD
Provider Business Mailing Address
First Line : PO BOX 844658
Second Line :
City : DALLAS
State : TX
Zip : 75284-4658
Country : US
Telephone Number : 800-994-0371
Fax Number : 254-215-9722
Provider Business Practice Location Address
First Line : 900 SCOTT AND WHITE DR
Second Line :
City : COLLEGE STATION
State : TX
Zip : 77845-6419
Country : US
Telephone Number : 979-207-7400
Fax Number : 979-207-7401
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/28/2020
Last Update Date : 01/12/2026

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