Provider Demographics
NPI:1497307656
Name:LIPPMAN, JONATHAN EDWARD
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:EDWARD
Last Name:LIPPMAN
Suffix:
Gender:M
Credentials:
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Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2003 KOOTENAI HEALTH WAY
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-6051
Mailing Address - Country:US
Mailing Address - Phone:208-625-3640
Mailing Address - Fax:208-625-3645
Practice Address - Street 1:700 W IRONWOOD DR STE 120
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4405
Practice Address - Country:US
Practice Address - Phone:208-625-3640
Practice Address - Fax:208-625-3645
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant