Healthcare Provider Details

I. General information

NPI: 1215917240
Provider Name (Legal Business Name): RICHARD I ZIPNICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 02/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E 3900 S STE 440
SALT LAKE CTY UT
84124-1349
US

IV. Provider business mailing address

1250 E 3900 S STE 440
SALT LAKE CTY UT
84124-1349
US

V. Phone/Fax

Practice location:
  • Phone: 602-667-7900
  • Fax: 602-667-7993
Mailing address:
  • Phone: 602-667-7900
  • Fax: 602-667-7993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number24633
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: