Provider Demographics
NPI:1396829925
Name:TRIPP, ALAN MATTHEW (DO)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:MATTHEW
Last Name:TRIPP
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-2783
Mailing Address - Country:US
Mailing Address - Phone:270-631-2412
Mailing Address - Fax:270-827-7558
Practice Address - Street 1:1413 N ELM ST
Practice Address - Street 2:SUITE 204
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-2768
Practice Address - Country:US
Practice Address - Phone:270-830-9973
Practice Address - Fax:270-830-9975
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY04032208600000X
IN02004102A208600000X
TN1876208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201119270Medicaid
IN00000793150OtherBCBS
TN103I024363Medicare PIN
IN00000793150OtherBCBS