Provider Demographics
NPI:1306883335
Name:ZIPPERER, WILLIAM P JR (DO)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:P
Last Name:ZIPPERER
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1663 E. HUBER ST.
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-3930
Mailing Address - Country:US
Mailing Address - Phone:480-250-4358
Mailing Address - Fax:480-962-1746
Practice Address - Street 1:1663 E HUBER ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-3930
Practice Address - Country:US
Practice Address - Phone:480-250-4358
Practice Address - Fax:480-962-1746
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2291207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ285032Medicaid
AZAZ0221630OtherBCBS
AZ2291OtherSTATE LICENSE NUMBER
AZAZ0221630OtherBCBS
AZCS2447Medicare ID - Type UnspecifiedRRMC GROUP-SW MEDICAL
AZAZ0221630OtherBCBS
AZZWCHJJMedicare ID - Type UnspecifiedGROUP-SOUTHWEST MEDICAL