Healthcare Provider Details

I. General information

NPI: 1275574451
Provider Name (Legal Business Name): JEFFREY MARK LIPMAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 06/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 N MIAMI AVE
MIAMI FL
33127-2906
US

IV. Provider business mailing address

3800 N MIAMI AVE
MIAMI FL
33127-2906
US

V. Phone/Fax

Practice location:
  • Phone: 305-576-4800
  • Fax: 305-576-4804
Mailing address:
  • Phone: 305-576-4800
  • Fax: 305-576-4804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS7523
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: