Provider Demographics
NPI:1558491936
Name:TRIPP, JONATHAN PAUL (DO)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:PAUL
Last Name:TRIPP
Suffix:
Gender:M
Credentials:DO
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Other - Credentials:
Mailing Address - Street 1:1411 FILLMORE ST
Mailing Address - Street 2:STE 600
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-3343
Mailing Address - Country:US
Mailing Address - Phone:208-933-4400
Mailing Address - Fax:208-933-4401
Practice Address - Street 1:1411 FILLMORE ST
Practice Address - Street 2:STE 600
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3343
Practice Address - Country:US
Practice Address - Phone:208-933-4400
Practice Address - Fax:208-933-4401
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2017-04-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IDO-0539207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H06751Medicare UPIN