Provider Demographics
NPI:1306062526
Name:TRIPP, GEORGE ALLEN (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:ALLEN
Last Name:TRIPP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:DEPARTMENT OF PEDIATRICS WILFORD HALL MEDICAL CENTER
Mailing Address - Street 2:2200 BERGQUIST DRIVE,SUITE 1
Mailing Address - City:LACKLAND AFB
Mailing Address - State:TX
Mailing Address - Zip Code:78236-5300
Mailing Address - Country:US
Mailing Address - Phone:210-292-5097
Mailing Address - Fax:210-292-4777
Practice Address - Street 1:DEPARTMENT OF PEDIATRICS WILFORD HALL MEDICAL CENTER
Practice Address - Street 2:2200 BERGQUIST DRIVE,SUITE 1
Practice Address - City:LACKLAND AFB
Practice Address - State:TX
Practice Address - Zip Code:78236-5300
Practice Address - Country:US
Practice Address - Phone:210-292-5097
Practice Address - Fax:210-292-4777
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE24616208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics