Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | Q1005 | TX |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | Q1005 | TX |
NPI | 1790001360 |
---|---|
Provider Name | Dr. Christopher Mark Ripperda |
First Address | Fort Worth, TX 76161-1205 |
Second Address | Fort Worth, TX 76104-4148 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2010 |
Last Update Date | 11/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
339897603 | (05) | TX |