Healthcare Provider Details

I. General information

NPI: 1891759254
Provider Name (Legal Business Name): ERNEST A JEPPSEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 05/21/2021
Certification Date: 05/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19-531 MCLANE STREET SUITE B
PALM SPRINGS CA
92262
US

IV. Provider business mailing address

PO BOX 2651
PALM SPRINGS CA
92263-2651
US

V. Phone/Fax

Practice location:
  • Phone: 760-288-4579
  • Fax: 760-288-3752
Mailing address:
  • Phone: 760-288-4579
  • Fax: 760-288-3752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number149728
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number149728
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC170515
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: