Provider Demographics
NPI:1497790828
Name:RUPPEL, RODNEY W (PHD)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:W
Last Name:RUPPEL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3560 DELAWARE ST
Mailing Address - Street 2:SUITE 502
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-3067
Mailing Address - Country:US
Mailing Address - Phone:409-898-8497
Mailing Address - Fax:409-899-9795
Practice Address - Street 1:3560 DELAWARE ST
Practice Address - Street 2:SUITE 502
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-3067
Practice Address - Country:US
Practice Address - Phone:409-898-8497
Practice Address - Fax:409-899-9795
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21208103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX035385602Medicaid
TX035385602Medicaid
TX8F3384Medicare PIN
TX00PR56Medicare UPIN