Provider Demographics
NPI:1578053138
Name:TRIPP, JAYSON (DO)
Entity Type:Individual
Prefix:
First Name:JAYSON
Middle Name:
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 1:3300 N TRIUMPH BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-6475
Mailing Address - Country:US
Mailing Address - Phone:844-692-4100
Mailing Address - Fax:801-901-1194
Practice Address - Street 1:203 FORT WADE RD UNIT 260
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32081-5159
Practice Address - Country:US
Practice Address - Phone:801-821-2333
Practice Address - Fax:801-901-1194
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-18
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS015504183500000X
UT12306263-12042084P0800X
CODR.00665252084P0800X
AZ0091172084P0800X
390200000X
NC2020-035872084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No183500000XPharmacy Service ProvidersPharmacist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program