1831344050 NPI number — DONALD W. DIPPE MD A PROFESSIONAL CORPORATION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831344050 NPI number — DONALD W. DIPPE MD A PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DONALD W. DIPPE MD A PROFESSIONAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DONALD W DIPPE, M.D. APC
Provider Other Organization Name Type Code:
5
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:
1831344050
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/26/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2841 DEBARR RD
Provider Second Line Business Mailing Address:
SUITE 35
Provider Business Mailing Address City Name:
ANCHORAGE
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99508-2967
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-264-1405
Provider Business Mailing Address Fax Number:
907-264-1404

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2841 DEBARR RD
Provider Second Line Business Practice Location Address:
SUITE 35
Provider Business Practice Location Address City Name:
ANCHORAGE
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99508-2967
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-264-1405
Provider Business Practice Location Address Fax Number:
907-264-1404
Provider Enumeration Date:
12/02/2008

Additional Information

Authorized Official

Authorized Official Last Name:
DIPPE
Authorized Official First Name:
DONALD
Authorized Official Middle Name:
WALTER
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
907-264-1405

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  1495 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: MD1495 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".




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