Provider Demographics
NPI:1225368830
Name:PAUL F WHIPPLE,D.O.,P.A.
Entity type:Organization
Organization Name:PAUL F WHIPPLE,D.O.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:WHIPPLE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:870-628-5391
Mailing Address - Street 1:557 KIRKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:STAR CITY
Mailing Address - State:AR
Mailing Address - Zip Code:71667-8843
Mailing Address - Country:US
Mailing Address - Phone:870-628-5391
Mailing Address - Fax:870-629-5393
Practice Address - Street 1:557 KIRKWOOD RD
Practice Address - Street 2:
Practice Address - City:STAR CITY
Practice Address - State:AR
Practice Address - Zip Code:71667-8843
Practice Address - Country:US
Practice Address - Phone:870-628-5391
Practice Address - Fax:870-629-5393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-04
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR-4516207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR124036003Medicaid
ARF24077Medicare UPIN
AR5J326Medicare PIN