Provider Demographics
NPI:1407842826
Name:TRIPP, TAMELA (MD)
Entity Type:Individual
Prefix:
First Name:TAMELA
Middle Name:
Last Name:TRIPP
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 1:50 E DUNLAP AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-2877
Mailing Address - Country:US
Mailing Address - Phone:602-944-4626
Mailing Address - Fax:602-944-2805
Practice Address - Street 1:50 E DUNLAP AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-2877
Practice Address - Country:US
Practice Address - Phone:602-944-4626
Practice Address - Fax:602-944-2805
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13488174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ070004490OtherRAILROAD MEDICARE
AZAZ0250130OtherBLUE CROSS BLUE SHIELD
AZ273706001Medicaid
AZ273706001Medicaid
AZ$$$$$$$$$Medicare PIN