Provider Demographics
NPI:1629308424
Name:TRIPP, TEEJAY GRANT (DO)
Entity Type:Individual
Prefix:
First Name:TEEJAY
Middle Name:GRANT
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:801-821-2333
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:480-210-0230
Is Sole Proprietor?:No
Enumeration Date:2009-12-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0056622084P0804X
NH195512084P0804X
NVCL00662084P0804X
FLOS192702084N0400X
UT11583541-12042084P0800X
COCDR.00005802084P0800X
AK1009702084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry