Healthcare Provider Details

I. General information

NPI: 1255389938
Provider Name (Legal Business Name): NEIL BAKER NIPPER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 N CLYDE MORRIS BLVD
DAYTONA BEACH FL
32114-2733
US

IV. Provider business mailing address

164 HERITAGE CIR
ORMOND BEACH FL
32174-4209
US

V. Phone/Fax

Practice location:
  • Phone: 386-238-3221
  • Fax:
Mailing address:
  • Phone: 850-543-0642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME108608
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: