Provider Demographics
NPI:1508930447
Name:LIPSON, BRAD (DO)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:
Last Name:LIPSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11903 SOUTHERN BLVD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-7644
Mailing Address - Country:US
Mailing Address - Phone:561-793-1475
Mailing Address - Fax:561-793-1478
Practice Address - Street 1:11903 SOUTHERN BLVD
Practice Address - Street 2:SUITE 108
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-7644
Practice Address - Country:US
Practice Address - Phone:561-793-1475
Practice Address - Fax:561-793-1478
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0009955207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL876ZMedicare UPIN