Provider Demographics
NPI:1861673741
Name:J. BARTON RIPPERGER DPM PC
Entity Type:Organization
Organization Name:J. BARTON RIPPERGER DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:LECKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-972-6131
Mailing Address - Street 1:13660 N 94TH DR
Mailing Address - Street 2:SUITE E1
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4836
Mailing Address - Country:US
Mailing Address - Phone:623-972-6131
Mailing Address - Fax:
Practice Address - Street 1:13660 N 94TH DR
Practice Address - Street 2:SUITE E1
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4836
Practice Address - Country:US
Practice Address - Phone:623-972-6131
Practice Address - Fax:623-977-0059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0379213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0842640001Medicare NSC
AZZ119381Medicare PIN
AZZ119380Medicare PIN