Healthcare Provider Details

I. General information

NPI: 1306821368
Provider Name (Legal Business Name): MARK V RIPPERDA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 07/31/2023
Certification Date: 07/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S DOBSON RD
MESA AZ
85202
US

IV. Provider business mailing address

PO BOX 7127
PHOENIX AZ
85011-7127
US

V. Phone/Fax

Practice location:
  • Phone: 480-456-9500
  • Fax: 480-820-7623
Mailing address:
  • Phone: 480-456-9500
  • Fax: 480-820-2623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number32297
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number32297
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number32297
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: