MEDICARE: DR. BRAD LIPSON D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	OS0009955	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508930447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRAD LIPSON D.O.

Provider Business Mailing Address
First Line	:	11903 SOUTHERN BLVD
Second Line	:	SUITE 108
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-7644
Country	:	US
Telephone Number	:	561-793-1475
Fax Number	:	561-793-1478

Provider Business Practice Location Address
First Line	:	11903 SOUTHERN BLVD
Second Line	:	SUITE 108
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-7644
Country	:	US
Telephone Number	:	561-793-1475
Fax Number	:	561-793-1478

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	04/13/2015

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