Provider Demographics
NPI:1346552932
Name:TIPPENS, ROBERT LANE (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:LANE
Last Name:TIPPENS
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 1:1200 FLEET GUARD RD
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38506
Mailing Address - Country:US
Mailing Address - Phone:931-528-9499
Mailing Address - Fax:
Practice Address - Street 1:205 MILLER SPRINGS COURT
Practice Address - Street 2:ATTN: CBO
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-5434
Practice Address - Country:US
Practice Address - Phone:931-528-9499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-12
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000014803207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine