Provider Demographics
NPI:1649470238
Name:RIPPS, LORRAINE G (MD)
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:G
Last Name:RIPPS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4828 N DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2341
Mailing Address - Country:US
Mailing Address - Phone:850-477-8109
Mailing Address - Fax:850-478-2412
Practice Address - Street 1:4810 N DAVIS HWY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2341
Practice Address - Country:US
Practice Address - Phone:850-474-8988
Practice Address - Fax:850-476-5312
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME71648207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL15309OtherBLUE SHIELD
P00448787OtherRR MEDICARE
FL279006800Medicaid
AL009911563Medicaid
AL59193684OtherBLUE SHIELD
F80968Medicare UPIN
FLAF508ZMedicare PIN