Provider Demographics
NPI:1356462519
Name:ANNE M. LIPTON, M.D., PH.D., P.A.
Entity Type:Organization
Organization Name:ANNE M. LIPTON, M.D., PH.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMURTREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-329-9812
Mailing Address - Street 1:7515 GREENVILLE AVE STE 503
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-3865
Mailing Address - Country:US
Mailing Address - Phone:214-345-5765
Mailing Address - Fax:
Practice Address - Street 1:7515 GREENVILLE AVE STE 503
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-3865
Practice Address - Country:US
Practice Address - Phone:214-345-5765
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2084N0400X103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00W459Medicare PIN
TXH11700Medicare UPIN