Provider Demographics
NPI:1245210368
Name:TRIPLETT, JOHNNY L (MD)
Entity Type:Individual
Prefix:MR
First Name:JOHNNY
Middle Name:L
Last Name:TRIPLETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOHNNY
Other - Middle Name:L
Other - Last Name:TRIPLETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3811 WYNDHAM AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93313
Mailing Address - Country:US
Mailing Address - Phone:661-834-3929
Mailing Address - Fax:661-834-2925
Practice Address - Street 1:4674 EAST BARKER WAY
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90814
Practice Address - Country:US
Practice Address - Phone:562-930-9059
Practice Address - Fax:562-930-9059
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53390207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A53390Medicaid
F96462Medicare UPIN
CA0A53390Medicare ID - Type Unspecified