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General NPI Number Information
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NPI Number | 1235108895
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Entity Type | Individual
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Provider Name | MARK B KIPP MD
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Gender | Male
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Dates
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Enumeration Date | 03/16/2006
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Last Update Date | 10/08/2025
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Provider Practice Location Address
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Address Line | 800 W RANDOL MILL RD
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City | ARLINGTON
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State | TX
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Zip | 76012-2504
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Country | US
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Telephone | 817-548-6202
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Fax |
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Provider Business Mailing Address
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Address Line | 5500 SYCAMORE SCHOOL RD STE 150
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City | FORT WORTH
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State | TX
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Zip | 76123-3053
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Country | US
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Telephone | 682-707-9707
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Fax | 682-707-9708
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | L1910
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License Number State | TX
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