Healthcare Provider Details

I. General information

NPI: 1013997956
Provider Name (Legal Business Name): RIPP A SMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 HEALTH PARK BLVD ATTN: ST. JOHNS RADIOLOGY ASSOCIATES
ST AUGUSTINE FL
32086-5784
US

IV. Provider business mailing address

PO BOX 1183
INDIANAPOLIS IN
46206-1183
US

V. Phone/Fax

Practice location:
  • Phone: 904-819-4398
  • Fax:
Mailing address:
  • Phone: 877-440-0553
  • Fax: 317-705-5060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2018011788
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME70749
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: