Provider Demographics
NPI:1275574451
Name:LIPMAN, JEFFREY MARK (DO)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:MARK
Last Name:LIPMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 N MIAMI AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33127-2906
Mailing Address - Country:US
Mailing Address - Phone:305-576-4800
Mailing Address - Fax:305-576-4804
Practice Address - Street 1:3800 N MIAMI AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33127-2906
Practice Address - Country:US
Practice Address - Phone:305-576-4800
Practice Address - Fax:305-576-4804
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7523207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260186900Medicaid
FL37733OtherBCBS OF FLORIDA
FLE2409Medicare ID - Type Unspecified
FL260186900Medicaid