Healthcare Provider Details

I. General information

NPI: 1295773737
Provider Name (Legal Business Name): WILLIAM TIPPETS D.O., MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 W. 5TH AVE.
SPOKANE WA
99204
US

IV. Provider business mailing address

PO BOX 8500 LOCKBOX 7642
PHILADELPHIA PA
19178-7642
US

V. Phone/Fax

Practice location:
  • Phone: 509-455-7844
  • Fax: 509-623-0415
Mailing address:
  • Phone: 813-281-8115
  • Fax: 813-281-8656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberH0062904
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberH0062904
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberDH0062904
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberOP60744732
License Number StateWA
# 5
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberOP60744732
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: