Provider Demographics
NPI:1154426187
Name:LIPSCOMB, JOSEPH ALLEN (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ALLEN
Last Name:LIPSCOMB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JODY
Other - Middle Name:
Other - Last Name:LIPSCOMB
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5012 S US HIGHWAY 75 STE 300
Mailing Address - Street 2:ATTN BILLING
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-4589
Mailing Address - Country:US
Mailing Address - Phone:903-416-6200
Mailing Address - Fax:
Practice Address - Street 1:5012 S US HIGHWAY 75 STE 110
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-4596
Practice Address - Country:US
Practice Address - Phone:903-416-6200
Practice Address - Fax:903-416-6201
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1206208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200065760AMedicaid
TX174127401Medicaid
OK200065760AMedicaid
I34019Medicare UPIN