Provider Demographics
NPI:1083690416
Name:PHIPPS, VIRGINIA CHRISTINE (DO)
Entity Type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:CHRISTINE
Last Name:PHIPPS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1095 MILITARY TRL # 1069
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7000
Mailing Address - Country:US
Mailing Address - Phone:484-626-1279
Mailing Address - Fax:
Practice Address - Street 1:600 HERITAGE DR STE 210
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-3097
Practice Address - Country:US
Practice Address - Phone:484-626-1279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229269207R00000X
FLOS13320207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02459447Medicaid
NY71V621Medicare ID - Type Unspecified
NY02459447Medicaid