Provider Demographics
NPI:1215917240
Name:ZIPNICK, RICHARD I (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:I
Last Name:ZIPNICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 E 3900 S
Mailing Address - Street 2:STE 440
Mailing Address - City:SALT LAKE CTY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1349
Mailing Address - Country:US
Mailing Address - Phone:602-667-7900
Mailing Address - Fax:602-667-7993
Practice Address - Street 1:1250 E 3900 S
Practice Address - Street 2:STE 440
Practice Address - City:SALT LAKE CTY
Practice Address - State:UT
Practice Address - Zip Code:84124-1349
Practice Address - Country:US
Practice Address - Phone:602-667-7900
Practice Address - Fax:602-667-7993
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-17
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24633207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ358912Medicaid
G07264Medicare UPIN
20WCHWM-31Medicare ID - Type Unspecified