Healthcare Provider Details

I. General information

NPI: 1215170808
Provider Name (Legal Business Name): ADAM JASON LIPMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2009
Last Update Date: 08/17/2020
Certification Date: 08/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E CYPRESS CREEK RD STE 304
FORT LAUDERDALE FL
33334-3522
US

IV. Provider business mailing address

800 E CYPRESS CREEK RD STE 304
FORT LAUDERDALE FL
33334-3522
US

V. Phone/Fax

Practice location:
  • Phone: 954-491-7758
  • Fax: 954-938-5339
Mailing address:
  • Phone: 954-491-7758
  • Fax: 954-938-5339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number271159
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberME 124045
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: