Provider Demographics
NPI:1457314734
Name:NIPPER, JEFFREY HJ (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:HJ
Last Name:NIPPER
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 1:9325 UPLAND LN N STE 205
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-4474
Mailing Address - Country:US
Mailing Address - Phone:763-416-0676
Mailing Address - Fax:763-416-0476
Practice Address - Street 1:9325 UPLAND LN N STE 205
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-4474
Practice Address - Country:US
Practice Address - Phone:763-416-0676
Practice Address - Fax:763-416-0476
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN31558207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1457314734Medicaid
200000887Medicare ID - Type Unspecified