Healthcare Provider Details

I. General information

NPI: 1104733732
Provider Name (Legal Business Name): SETH LIPSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 MEDICAL CENTER ROAD
FORT HOOD TX
76544
US

IV. Provider business mailing address

1101 BCH WAY UNIT 328
GEORGETOWN TX
78633-2655
US

V. Phone/Fax

Practice location:
  • Phone: 264-288-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: