Provider Demographics
NPI:1003809567
Name:TRIPP, COURTNEY TODD (DO)
Entity type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:TODD
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 1:3050 RICHFIELD DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-4535
Mailing Address - Country:US
Mailing Address - Phone:719-445-2282
Mailing Address - Fax:
Practice Address - Street 1:3050 RICHFIELD DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-4535
Practice Address - Country:US
Practice Address - Phone:719-445-2282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS010785L2085R0202X
CO517762085R0202X
CODR.00494392085R0202X
CA20A107522085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOS14907OtherFLORIDA LICENSE
CODR.0049439OtherCOLORADO LICENSE