Provider Demographics
NPI:1366437667
Name:RUPPERT, JAMES (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:RUPPERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6485 DAY ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-0930
Mailing Address - Country:US
Mailing Address - Phone:951-697-7823
Mailing Address - Fax:951-697-7828
Practice Address - Street 1:6485 DAY ST
Practice Address - Street 2:SUITE 206
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-0930
Practice Address - Country:US
Practice Address - Phone:951-697-7823
Practice Address - Fax:951-697-7828
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG61972207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA080046140OtherRAILROAD MEDICARE
CA00G619721Medicaid
CA080046140OtherRAILROAD MEDICARE
CA00G619721Medicaid