Provider Demographics
NPI:1346330081
Name:LIPPMANN, BRUCE JEFFREY (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:JEFFREY
Last Name:LIPPMANN
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 1:1209 S BIG BEND BLVD UNIT 179106
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-0501
Mailing Address - Country:US
Mailing Address - Phone:573-267-2318
Mailing Address - Fax:
Practice Address - Street 1:1009 EXECUTIVE PARKWAY DR
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-6324
Practice Address - Country:US
Practice Address - Phone:573-267-2318
Practice Address - Fax:314-293-6811
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3E22207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO340017501OtherRAILROAD MEDICARE
MO202132247Medicaid
MO004011536Medicare PIN
MO340017501OtherRAILROAD MEDICARE
MO202132247Medicaid