=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215170808
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ADAM JASON LIPMAN MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/12/2009
-----------------------------------------------------
Last Update Date | 08/17/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 800 E CYPRESS CREEK RD STE 304
-----------------------------------------------------
City | FORT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33334-3522
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-491-7758
-----------------------------------------------------
Fax | 954-938-5339
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 800 E CYPRESS CREEK RD STE 304
-----------------------------------------------------
City | FORT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33334-3522
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-491-7758
-----------------------------------------------------
Fax | 954-938-5339
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207XX0005X
-----------------------------------------------------
Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
-----------------------------------------------------
License Number | 271159
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207XX0005X
-----------------------------------------------------
Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
-----------------------------------------------------
License Number | ME 124045
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------