Healthcare Provider Details

I. General information

NPI: 1306869557
Provider Name (Legal Business Name): JEFFREY RIPPERDA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 12/11/2020
Certification Date: 12/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 SOUTH HOSPITAL DRIVE
MURPHYSBORO IL
62966-3333
US

IV. Provider business mailing address

109 CALIFORNIA P O BOX 577
CARTERVEILL IL
62918-0577
US

V. Phone/Fax

Practice location:
  • Phone: 618-687-3418
  • Fax: 618-687-1859
Mailing address:
  • Phone: 618-985-8221
  • Fax: 618-985-4635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036-116271
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: