Healthcare Provider Details

I. General information

NPI: 1336192822
Provider Name (Legal Business Name): CAROL HIPPENMEYER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 12/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 W REX ALLEN DR
WILLCOX AZ
85643-1009
US

IV. Provider business mailing address

2155 E GAZANIA LN
TUCSON AZ
85719-1555
US

V. Phone/Fax

Practice location:
  • Phone: 800-444-7009
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberL26801
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: