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Individual

BETH CONRAD RUPP

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
600 N JORDAN AVE, BLOOMINGTON, IN 47405-3190
(812) 855-0093
Mailing address
600 N JORDAN AVE, BLOOMINGTON, IN 47405-3190
(812) 855-0093

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01062309A
IN
207Q00000X
Family Medicine Physician
MD00043577
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
8406910
WA
Enumeration date
02/09/2006
Last updated
09/11/2007
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