Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | MD2006-0458 | NM |
N | 207KA0200X | Allergist | MD2006-0458 | NM |
NPI | 1568414985 |
---|---|
Provider Name | Dr. Michael Richard Rupp |
First Address | Las Cruces, NM 88011-8287 |
Second Address | Las Cruces, NM 88011-8287 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2006 |
Last Update Date | 30/01/2019 |