Healthcare Provider Details

I. General information

NPI: 1790611234
Provider Name (Legal Business Name): RIPOR AD CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1561 W FAIRBANKS AVE STE 100B
WINTER PARK FL
32789-4678
US

IV. Provider business mailing address

1561 W FAIRBANKS AVE STE 100B
WINTER PARK FL
32789-4678
US

V. Phone/Fax

Practice location:
  • Phone: 321-972-1106
  • Fax:
Mailing address:
  • Phone: 321-972-1102
  • Fax: 321-972-1135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. EVAN THOMAS
Title or Position: CMO
Credential: MD
Phone: 321-972-1102