Provider Demographics
NPI:1861451338
Name:RUPARD, JOSEPH HOWARD (M D)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:HOWARD
Last Name:RUPARD
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:HOWARD
Other - Middle Name:
Other - Last Name:RUPARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:M D
Mailing Address - Street 1:883 UNION ST
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37160-2607
Mailing Address - Country:US
Mailing Address - Phone:931-685-1145
Mailing Address - Fax:931-685-8014
Practice Address - Street 1:883 UNION STREET
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-3108
Practice Address - Country:US
Practice Address - Phone:931-685-1145
Practice Address - Fax:931-685-8014
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-22
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD024783207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3078581Medicaid
TN$$$$$$$$$OtherSOCIAL SECURITY
TN$$$$$$$$$OtherSOCIAL SECURITY
TN3078581Medicaid
TN3078581Medicare ID - Type Unspecified