Provider Demographics
NPI:1982661641
Name:TRIPP, BRUCE G (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:G
Last Name:TRIPP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 STARLING ST
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4265
Mailing Address - Country:US
Mailing Address - Phone:912-466-5100
Mailing Address - Fax:912-446-5113
Practice Address - Street 1:2500 STARLING ST
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4265
Practice Address - Country:US
Practice Address - Phone:912-466-5100
Practice Address - Fax:912-446-5113
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA028910174400000X, 2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00213844OtherMEDICARE RAILROAD
FL273597100Medicaid
GAP00213844OtherMEDICARE RAILROAD