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General NPI Number Information
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NPI Number | 1861459687
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Entity Type | Individual
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Provider Name | CRAIG CLAYTON TIPPING D.O.
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Gender | Male
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Dates
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Enumeration Date | 04/26/2006
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Last Update Date | 06/02/2014
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Provider Practice Location Address
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Address Line | 3202 MCINTOSH CIR SUITE 302
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City | JOPLIN
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State | MO
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Zip | 64804-3646
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Country | US
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Telephone | 417-347-8420
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Fax | 417-347-8422
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Provider Business Mailing Address
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Address Line | PO BOX 3810
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City | JOPLIN
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State | MO
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Zip | 64803-3810
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Country | US
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Telephone | 417-347-8420
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Fax | 417-347-8422
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 38965
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2014013679
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License Number State | MO
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