Individual
DR. ANDREY RUPASOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
52 W UNDERWOOD ST, ORLANDO, FL 32806-1110
(321) 842-8475
Mailing address
52 W UNDERWOOD ST, ORLANDO, FL 32806-1110
(321) 842-8475
(407) 849-6470
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
286233
NY
2085R0202X
Diagnostic Radiology Physician
Primary
OS16979
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
107832900
—
FL
01
—
MZ357
MEDICARE PTAN OHRI
FL
01
—
PT879
MEDICARE PTAN OHMG
FL
01
—
UQYIJ
BCBS
FL
Enumeration date
01/23/2014
Last updated
04/05/2023
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