Healthcare Provider Details

I. General information

NPI: 1558533620
Provider Name (Legal Business Name): JAMES DAVIS TIPTON JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JIMMY TIPTON M.D.

II. Dates (important events)

Enumeration Date: 03/29/2008
Last Update Date: 03/05/2021
Certification Date: 03/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4420 DIXIE HWY STE 126
LOUISVILLE KY
40216-2994
US

IV. Provider business mailing address

PO BOX 776351
CHICAGO IL
60677-6351
US

V. Phone/Fax

Practice location:
  • Phone: 502-810-3780
  • Fax: 502-394-3607
Mailing address:
  • Phone: 502-588-9490
  • Fax: 502-272-5116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number44052
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: