Healthcare Provider Details

I. General information

NPI: 1881031052
Provider Name (Legal Business Name): BRIAN L. TRIPP D.V.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2013
Last Update Date: 05/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 DIXIE HIGHWAY
LOUISVILLE KY
40216
US

IV. Provider business mailing address

2401 DIXIE HIGHWAY
LOUISVILLE KY
40216
US

V. Phone/Fax

Practice location:
  • Phone: 502-778-8317
  • Fax: 502-778-8317
Mailing address:
  • Phone: 502-778-8317
  • Fax: 502-778-3682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License NumberKY3878
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: