Healthcare Provider Details

I. General information

NPI: 1275594228
Provider Name (Legal Business Name): MARK GREGORY LIPE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 06/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 W MEMORIAL RD ER DEPT.
OKLAHOMA CITY OK
73120-8304
US

IV. Provider business mailing address

4401 W MEMORIAL RD SUITE 121
OKLAHOMA CITY OK
73134-1785
US

V. Phone/Fax

Practice location:
  • Phone: 405-752-3733
  • Fax: 405-749-4561
Mailing address:
  • Phone: 405-751-4664
  • Fax: 405-749-4561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number16509
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: