Provider Demographics
NPI:1154524288
Name:RUPP, ANTHONY JEROME (MD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:JEROME
Last Name:RUPP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:605-328-8101
Practice Address - Street 1:1205 S GRANGE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-0407
Practice Address - Country:US
Practice Address - Phone:605-328-8100
Practice Address - Fax:605-328-8101
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN54579207RN0300X
SD8081207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology