Healthcare Provider Details

I. General information

NPI: 1750471777
Provider Name (Legal Business Name): CRAIG DONALD ZIPPE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 11/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 COLORADO AVE STE 250
TURLOCK CA
95382-2710
US

IV. Provider business mailing address

1801 COLORADO AVE STE 250
TURLOCK CA
95382-2710
US

V. Phone/Fax

Practice location:
  • Phone: 209-647-3950
  • Fax: 209-632-3021
Mailing address:
  • Phone: 209-647-3950
  • Fax: 209-632-3021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number35-067297
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number35067297Z
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberG164376
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: