Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 32185 | NC |
N | 207R00000X | Internist | 32185 | NC |
N | 111NI0900X | Internist | 32185 | NC |
N | 208200000X | Surgeon | 32185 | NC |
N | 208600000X | Surgeon | 32185 | NC |
NPI | 1104829142 |
---|---|
Provider Name | Henry Franklin Tripp JR. |
First Address | Winston Salem, NC 27106-2240 |
Second Address | Winston Salem, NC 27106-2240 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2005 |
Last Update Date | 08/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1231R | BCBS (01) | NC |
891231R | (05) | NC |
H02087 | (02) | NC |