Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 35-03-1374 | OH |
NPI | 1497753685 |
---|---|
Provider Name | Garry H Rupp |
First Address | Columbus, OH 43218-3027 |
Second Address | Columbus, OH 43231-2859 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2005 |
Last Update Date | 19/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0245587 | (05) | OH |
C01136 | (02) |