Provider Demographics
NPI:1104009471
Name:JAMES W VAN RIPER DO PA
Entity Type:Organization
Organization Name:JAMES W VAN RIPER DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:VAN RIPER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:432-337-4782
Mailing Address - Street 1:410 N HANCOCK AVE
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-5140
Mailing Address - Country:US
Mailing Address - Phone:432-337-4782
Mailing Address - Fax:432-337-4785
Practice Address - Street 1:410 N HANCOCK AVE
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-5140
Practice Address - Country:US
Practice Address - Phone:432-337-4782
Practice Address - Fax:432-337-4785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00348WMedicare PIN