Provider Demographics
NPI:1306872528
Name:RIPLEY, BRET D (DO)
Entity type:Individual
Prefix:
First Name:BRET
Middle Name:D
Last Name:RIPLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1867 AMHERST ST STE 101
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2869
Mailing Address - Country:US
Mailing Address - Phone:540-667-8724
Mailing Address - Fax:540-662-5638
Practice Address - Street 1:1867 AMHERST ST STE 101
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2869
Practice Address - Country:US
Practice Address - Phone:540-667-8724
Practice Address - Fax:540-662-5638
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH34006392207Q00000X
KY02853207Q00000X
IADO-04444207Q00000X
VA0102201949207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA129363OtherCOMMUNITY HEALTH
VA137797OtherANTHEM
KY64088040Medicaid
VA7650702OtherAETNA
WV3810001273Medicaid
VA861102088OtherTRICARE
VA1306995717Medicaid
VA1306995717Medicaid
VA129363OtherCOMMUNITY HEALTH
WV3810001273Medicaid
VAC09450Medicare PIN
KY64088040Medicaid