Healthcare Provider Details

I. General information

NPI: 1538130109
Provider Name (Legal Business Name): DAVID HIPKIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 11/16/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

463 S. LAKE POWELL BLVD
PAGE AZ
86040-0790
US

IV. Provider business mailing address

PO BOX 790
PAGE AZ
86040-0790
US

V. Phone/Fax

Practice location:
  • Phone: 928-645-0945
  • Fax: 928-645-2364
Mailing address:
  • Phone: 928-645-0945
  • Fax: 928-645-2364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number21930
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11352
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: