1770526485 NPI number — DR. PAUL TIPTON DPM

Table of content: DR. PAUL TIPTON DPM (NPI 1770526485)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770526485 NPI number — DR. PAUL TIPTON DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TIPTON
Provider First Name:
PAUL
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770526485
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6801 DIXIE HWY
Provider Second Line Business Mailing Address:
SUITE 134
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40258-3913
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-447-4500
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6801 DIXIE HWY
Provider Second Line Business Practice Location Address:
SUITE 134
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40258-3913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-447-4500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/13/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  00133 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000047475 . This is a "ANTHEM BCBS ID #" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 610992425 . This is a "HUMANA ID #" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 610992425 . This is a "CIGNA ID #" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 80001332 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".