Healthcare Provider Details

I. General information

NPI: 1518940832
Provider Name (Legal Business Name): FRED BARNETT LIPOVITCH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 12/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 N PLAZA DR
APACHE JUNCTION AZ
85120-5501
US

IV. Provider business mailing address

16623 N 59TH PL
SCOTTSDALE AZ
85254-1251
US

V. Phone/Fax

Practice location:
  • Phone: 480-983-0065
  • Fax:
Mailing address:
  • Phone: 602-293-3550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number5672
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number5672
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number5672
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code2084H0002X
TaxonomyHospice and Palliative Medicine (Psychiatry & Neurology) Physician
License Number5672
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code2084P0005X
TaxonomyNeurodevelopmental Disabilities Physician
License Number5672
License Number StateAZ
# 6
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number5672
License Number StateAZ
# 7
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number5672
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: