Provider Demographics
NPI:1336126127
Name:GIPPLE, JOHN RANDY (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RANDY
Last Name:GIPPLE
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 1:1616 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761-3453
Mailing Address - Country:US
Mailing Address - Phone:563-264-9185
Mailing Address - Fax:563-264-9182
Practice Address - Street 1:1616 CEDAR ST
Practice Address - Street 2:
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-3475
Practice Address - Country:US
Practice Address - Phone:563-264-9185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA29857207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1112011Medicaid
IAI14293Medicare ID - Type Unspecified
IA1112011Medicaid
IAF45567Medicare UPIN