Provider Demographics
NPI:1235572678
Name:PIPPIN, MICAH M (MD)
Entity Type:Individual
Prefix:
First Name:MICAH
Middle Name:M
Last Name:PIPPIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:821 ELLIOTT ST
Mailing Address - Street 2:DEPT OF FAMILY MEDICINE
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-7732
Mailing Address - Country:US
Mailing Address - Phone:318-441-1030
Mailing Address - Fax:
Practice Address - Street 1:821 ELLIOTT ST
Practice Address - Street 2:DEPT OF FAMILY MEDICINE
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-7732
Practice Address - Country:US
Practice Address - Phone:318-441-1030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-16
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA303212207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine