Provider Demographics
NPI:1013997956
Name:SMITH, RIPP A (MD)
Entity Type:Individual
Prefix:
First Name:RIPP
Middle Name:A
Last Name:SMITH
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:PO BOX 1183
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-1183
Mailing Address - Country:US
Mailing Address - Phone:877-440-0553
Mailing Address - Fax:317-705-5060
Practice Address - Street 1:400 HEALTH PARK BLVD
Practice Address - Street 2:ATTN: ST. JOHNS RADIOLOGY ASSOCIATES
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5784
Practice Address - Country:US
Practice Address - Phone:904-819-4398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME707492085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL379908500Medicaid
FL31955YMedicare PIN
FL379908500Medicaid