Provider Demographics
NPI:1629166541
Name:BENJAMIN TRIPP M D P A
Entity Type:Organization
Organization Name:BENJAMIN TRIPP M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:TRIPP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-499-8048
Mailing Address - Street 1:5130 LINTON BLVD
Mailing Address - Street 2:SUITE C-1
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-6596
Mailing Address - Country:US
Mailing Address - Phone:561-499-8048
Mailing Address - Fax:561-499-8762
Practice Address - Street 1:5130 LINTON BLVD
Practice Address - Street 2:SUITE C-1
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6596
Practice Address - Country:US
Practice Address - Phone:561-499-8048
Practice Address - Fax:561-499-8762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBR299AMedicare PIN
1321510001Medicare NSC