Provider Demographics
NPI:1164476164
Name:ZIPSIR, JAIME
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:ZIPSIR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3841 PIPER ST
Mailing Address - Street 2:T300
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4624
Mailing Address - Country:US
Mailing Address - Phone:907-563-3103
Mailing Address - Fax:907-561-1862
Practice Address - Street 1:3841 PIPER ST
Practice Address - Street 2:T300
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4624
Practice Address - Country:US
Practice Address - Phone:907-563-3103
Practice Address - Fax:907-561-1862
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAK618363AM0700X
VT055-0031086363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK152894Medicare ID - Type Unspecified
AKQ05623Medicare UPIN