Provider Demographics
NPI:1770515017
Name:RIPP, THOMAS VICTOR (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:VICTOR
Last Name:RIPP
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 1:4000 MEDICAL PKWY
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401-7854
Mailing Address - Country:US
Mailing Address - Phone:903-454-6481
Mailing Address - Fax:903-454-6486
Practice Address - Street 1:4000 MEDICAL PKWY
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-7854
Practice Address - Country:US
Practice Address - Phone:903-454-6481
Practice Address - Fax:903-454-6486
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG6994207Y00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110497801Medicaid
TX110497801Medicaid
TXB25935Medicare UPIN
TX040005409Medicare PIN