Provider Demographics
NPI:1538120969
Name:TRIPURANENI, AJAY (MD)
Entity Type:Individual
Prefix:
First Name:AJAY
Middle Name:
Last Name:TRIPURANENI
Suffix:
Gender:M
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:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2401 S 31ST ST
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76508-2316
Practice Address - Country:US
Practice Address - Phone:254-724-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD24630207RC0000X, 207RC0001X, 207R00000X
WAMD60671202207RC0001X, 207RC0000X
TXT6399207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR838334001OtherBCBS-ROSEBURG
OR858464003OtherBCBS-SPRINGFIELD
ORP00172920OtherRR MEDICARE
OR838366006OtherBCBS-MCMINNVILLE
OR227289Medicaid
OR844477013OtherBCBS-GRANTS PASS
OR858463003OtherBCBS-MEDFORD
ORP00172920OtherRR MEDICARE
ORR119831Medicare PIN
OR844477013OtherBCBS-GRANTS PASS
OR858464003OtherBCBS-SPRINGFIELD