Provider Demographics
NPI:1174510234
Name:RUPPERT, RONALD C (DO)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:C
Last Name:RUPPERT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2859 STATE ST STE 101
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8495
Mailing Address - Country:US
Mailing Address - Phone:541-282-6505
Mailing Address - Fax:541-282-6520
Practice Address - Street 1:2859 STATE ST STE 101
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8495
Practice Address - Country:US
Practice Address - Phone:541-282-6505
Practice Address - Fax:541-282-6520
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO166272207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500675318Medicaid
OR500675318Medicaid
NVAP690XMedicare PIN
NV1174510234Medicaid