Provider Demographics
NPI:1790899185
Name:HOLLISTER, RIPLEY ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:RIPLEY
Middle Name:ROBERT
Last Name:HOLLISTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2855 DUBLIN BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-1662
Mailing Address - Country:US
Mailing Address - Phone:719-265-6464
Mailing Address - Fax:719-265-6750
Practice Address - Street 1:2855 DUBLIN BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-1662
Practice Address - Country:US
Practice Address - Phone:719-265-6464
Practice Address - Fax:719-265-6750
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO30292207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COA97781Medicare UPIN