Provider Demographics
NPI:1306821368
Name:RIPPERDA, MARK V (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:V
Last Name:RIPPERDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7127
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85011-7127
Mailing Address - Country:US
Mailing Address - Phone:480-456-9500
Mailing Address - Fax:480-820-2623
Practice Address - Street 1:1400 S DOBSON RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202
Practice Address - Country:US
Practice Address - Phone:480-456-9500
Practice Address - Fax:480-820-7623
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ32297208000000X, 2080P0204X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ839722Medicaid
AZ839722Medicaid
C47310Medicare UPIN