Provider Demographics
NPI:1275596967
Name:LIPPERD, DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:
Last Name:LIPPERD
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 1:4274 CAHABA HEIGHTS CT
Mailing Address - Street 2:SUITE 130
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35243-5712
Mailing Address - Country:US
Mailing Address - Phone:205-977-8484
Mailing Address - Fax:205-977-2173
Practice Address - Street 1:4274 CAHABA HEIGHTS CT
Practice Address - Street 2:SUITE 130
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243-5712
Practice Address - Country:US
Practice Address - Phone:205-977-8484
Practice Address - Fax:205-977-2173
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20180207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009912603Medicaid
AL009912603Medicaid
ALG41163Medicare UPIN
AL051553202Medicare ID - Type Unspecified