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: 04/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 JACKSON CIRCLE
VALPARAISO FL
32580
US

IV. Provider business mailing address

350 JACKSON CIRCLE
VALPARAISO FL
32580-1638
US

V. Phone/Fax

Practice location:
  • Phone: 850-883-8288
  • Fax: 850-883-8192
Mailing address:
  • Phone: 850-543-0642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number31138
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: