Healthcare Provider Details

I. General information

NPI: 1477586014
Provider Name (Legal Business Name): GEORGE PHILIP CIPORKIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 12/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 2ND ST N UNIT # 701
ST PETERSBURG FL
33701-3029
US

IV. Provider business mailing address

475 2ND ST N UNIT # 701
ST PETERSBURG FL
33701-3029
US

V. Phone/Fax

Practice location:
  • Phone: 727-365-0906
  • Fax:
Mailing address:
  • Phone: 727-365-0906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME77713
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: