Organization Name: | TRIPP FAMILY MEDICINE, P.A. |
NPI Number: | 1003946302 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JONATHAN PAUL TRIPP (PRESIDENT) |
Mailing Address: | 2830 E Brown Rd Suite 1 Mesa |
State: | AZ US |
Postal Code: | 852135430 |
Phone Number: | 4808307546 |
Fax Number: | 4808307550 |
NPI Enumeration Date: | 03/06/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | 4321 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AZ |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |