Provider Demographics
NPI:1063673127
Name:RIPLEY, AMY WALENTA (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:WALENTA
Last Name:RIPLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4144 N CENTRAL EXPY
Mailing Address - Street 2:SUITE 360
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-3140
Mailing Address - Country:US
Mailing Address - Phone:214-252-3511
Mailing Address - Fax:214-826-6858
Practice Address - Street 1:4144 N CENTRAL EXPY
Practice Address - Street 2:SUITE 360
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-3140
Practice Address - Country:US
Practice Address - Phone:214-252-3511
Practice Address - Fax:214-826-6858
Is Sole Proprietor?:No
Enumeration Date:2008-06-21
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT193252390200000X
TXP2058207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8EH087OtherBCBS
TX303283104Medicaid
TXP01358207OtherRR
TX339109YK6UMedicare PIN