Provider Demographics
NPI:1063724987
Name:SHIPP, LYNDSAY R (MD)
Entity type:Individual
Prefix:DR
First Name:LYNDSAY
Middle Name:R
Last Name:SHIPP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1158
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-1158
Mailing Address - Country:US
Mailing Address - Phone:662-371-1326
Mailing Address - Fax:
Practice Address - Street 1:1626 HIGHWAY 30 EAST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655
Practice Address - Country:US
Practice Address - Phone:662-371-1326
Practice Address - Fax:662-371-1325
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-08
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS23000207N00000X
MST-2359207R00000X
MS2300207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS23000OtherMEDICAL LICENSE
MST-2359OtherMS TEMP MEDICAL LICENSE