Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 32297 | AZ |
N | 2080P0204X | Pediatric Emergency Doctor | 32297 | AZ |
NPI | 1306821368 |
---|---|
Provider Name | Mark V Ripperda |
First Address | Phoenix, AZ 85011-7127 |
Second Address | Mesa, AZ 85202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
839722 | (05) | AZ |
C47310 | (02) |