Healthcare Provider Details

I. General information

NPI: 1154426187
Provider Name (Legal Business Name): JOSEPH ALLEN LIPSCOMB M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JODY LIPSCOMB M.D.

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 04/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5012 S US HIGHWAY 75 STE 110
DENISON TX
75020-4596
US

IV. Provider business mailing address

5012 S US HIGHWAY 75 STE 300 ATTN BILLING
DENISON TX
75020-4589
US

V. Phone/Fax

Practice location:
  • Phone: 903-416-6200
  • Fax: 903-416-6201
Mailing address:
  • Phone: 903-416-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberM1206
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: