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General NPI Number Information
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NPI Number | 1396829925
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Entity Type | Individual
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Provider Name | ALAN MATTHEW TRIPP D.O.
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Gender | Male
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 10/19/2016
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Provider Practice Location Address
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Address Line | 1413 N ELM ST SUITE 204
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City | HENDERSON
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State | KY
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Zip | 42420-2768
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Country | US
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Telephone | 270-830-9973
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Fax | 270-830-9975
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Provider Business Mailing Address
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Address Line | 1305 N ELM ST
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City | HENDERSON
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State | KY
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Zip | 42420-2783
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Country | US
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Telephone | 270-631-2412
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Fax | 270-827-7558
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 04032
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 02004102A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 1876
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License Number State | TN
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