Provider Demographics
NPI:1558654921
Name:RIPP, GAVIN PATRICK (DPM)
Entity Type:Individual
Prefix:
First Name:GAVIN
Middle Name:PATRICK
Last Name:RIPP
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6620 COYLE AVE
Mailing Address - Street 2:STE 202
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-6333
Mailing Address - Country:US
Mailing Address - Phone:916-961-3434
Mailing Address - Fax:
Practice Address - Street 1:6620 COYLE AVE
Practice Address - Street 2:STE 202
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-6333
Practice Address - Country:US
Practice Address - Phone:916-961-3434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-18
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5115213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery