Healthcare Provider Details

I. General information

NPI: 1356432330
Provider Name (Legal Business Name): GEORGE E RIPPIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 12/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1335 VALENTINE ST
MELBOURNE FL
32901-3127
US

IV. Provider business mailing address

1335 VALENTINE ST
MELBOURNE FL
32901-3127
US

V. Phone/Fax

Practice location:
  • Phone: 321-956-2986
  • Fax: 321-956-9430
Mailing address:
  • Phone: 321-956-2986
  • Fax: 321-956-9430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number207ZD0900X
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: