Provider Demographics
NPI:1699780155
Name:RUPP, FREDERICK W JR (MD)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:W
Last Name:RUPP
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:933 BRADBURY DR. SE
Mailing Address - Street 2:SUITE 2222
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106
Mailing Address - Country:US
Mailing Address - Phone:505-272-3120
Mailing Address - Fax:505-272-8060
Practice Address - Street 1:2211 LOMAS BLVD. NE
Practice Address - Street 2:UNM HOSPITAL
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131
Practice Address - Country:US
Practice Address - Phone:505-272-0011
Practice Address - Fax:505-272-5821
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2012-05-04
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Provider Licenses
StateLicense IDTaxonomies
NM91-2932085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NME88211Medicare UPIN