Healthcare Provider Details

I. General information

NPI: 1851371769
Provider Name (Legal Business Name): BRIAN J. IPSEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 02/27/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3302 MCINTOSH CIR STE 2
JOPLIN MO
64804-3639
US

IV. Provider business mailing address

PO BOX 3810
JOPLIN MO
64803-3810
US

V. Phone/Fax

Practice location:
  • Phone: 417-347-6100
  • Fax: 417-347-6109
Mailing address:
  • Phone: 417-347-8400
  • Fax: 417-347-5818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number04-29574
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number2000164182
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: