MEDICARE: RON RUPPERT PC

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
1	207Q00000X	Family Medicine Physician	DO488	NV

General Provider Information

NPI Number	:	1972622363
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RON RUPPERT PC

Provider Business Mailing Address
First Line	:	4275 BURNHAM AVE
Second Line	:	SUITE 365
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-8207
Country	:	US
Telephone Number	:	702-731-1105
Fax Number	:	702-731-1201

Provider Business Practice Location Address
First Line	:	4275 BURNHAM AVE
Second Line	:	SUITE 365
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-8207
Country	:	US
Telephone Number	:	702-731-1105
Fax Number	:	702-731-1201

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RONALD C RUPPERT
Credential	:	D.O.
Telephone Number	:	702-731-1105

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	10/11/2007

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