Provider Demographics
NPI:1376839472
Name:RIPPLE, STEPHEN RANDALL (DO)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:RANDALL
Last Name:RIPPLE
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:5905 CAPISTRANO AVE STE C
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-7219
Mailing Address - Country:US
Mailing Address - Phone:805-461-7144
Mailing Address - Fax:805-461-7141
Practice Address - Street 1:5905 CAPISTRANO AVE STE C
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-7219
Practice Address - Country:US
Practice Address - Phone:805-461-7144
Practice Address - Fax:805-461-7141
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A4260207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE07290Medicare UPIN