Provider Demographics
NPI:1457398703
Name:RUPPER, RANDALL W (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:W
Last Name:RUPPER
Suffix:
Gender:M
Credentials:MD, MPH
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Mailing Address - Street 1:GRECC (182) BLDG. 2, VAMC
Mailing Address - Street 2:500 FOOTHILL DRIVE
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84148-0001
Mailing Address - Country:US
Mailing Address - Phone:801-582-1565
Mailing Address - Fax:801-584-5640
Practice Address - Street 1:GRECC (182) BLDG. 2, VAMC
Practice Address - Street 2:500 FOOTHILL DRIVE
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84148-0001
Practice Address - Country:US
Practice Address - Phone:801-582-1565
Practice Address - Fax:801-584-5640
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT5368958-1205207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H38224Medicare UPIN