Provider Demographics
NPI:1235129420
Name:LIPPER, BENNET (MD)
Entity Type:Individual
Prefix:
First Name:BENNET
Middle Name:
Last Name:LIPPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 S VICTORIA AVE # L4640
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93009-0003
Mailing Address - Country:US
Mailing Address - Phone:805-437-0900
Mailing Address - Fax:805-987-2878
Practice Address - Street 1:3801 LAS POSAS RD STE 214
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-1426
Practice Address - Country:US
Practice Address - Phone:805-437-0900
Practice Address - Fax:805-987-2878
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG68798207RC0200X, 207RP1001X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ80185ZMedicaid
CAWG68798BMedicare PIN
W1153Medicare UPIN