Provider Demographics
NPI:1295723864
Name:RIPPERGER, J BARTON (DPM)
Entity type:Individual
Prefix:
First Name:J
Middle Name:BARTON
Last Name:RIPPERGER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13660 N 94TH DR
Mailing Address - Street 2:SUITE E1
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4836
Mailing Address - Country:US
Mailing Address - Phone:623-933-5787
Mailing Address - Fax:623-933-5787
Practice Address - Street 1:13660 N 94TH DR
Practice Address - Street 2:SUITE E1
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4836
Practice Address - Country:US
Practice Address - Phone:623-933-5787
Practice Address - Fax:623-933-5787
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0379213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0191310OtherBLUE CROSS BLUE SHIELD
AZ395394Medicaid
AZAZ0191310OtherBLUE CROSS BLUE SHIELD
AZZ119380Medicare PIN
AZZ119381Medicare PIN
AZ395394Medicaid
AZ0842640001Medicare NSC