Provider Demographics
NPI:1518989029
Name:LIPSCOMB, JANE WADE (MD)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:WADE
Last Name:LIPSCOMB
Suffix:
Gender:F
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:PO BOX 430
Mailing Address - Street 2:
Mailing Address - City:BOGALUSA
Mailing Address - State:LA
Mailing Address - Zip Code:70429-0430
Mailing Address - Country:US
Mailing Address - Phone:985-730-6700
Mailing Address - Fax:985-730-6709
Practice Address - Street 1:433 PLAZA STREET
Practice Address - Street 2:SUITE A16
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427
Practice Address - Country:US
Practice Address - Phone:985-730-7066
Practice Address - Fax:985-730-7068
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2008-01-07
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2008-01-07
Provider Licenses
StateLicense IDTaxonomies
LA05336R207ZC0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1956031Medicaid
LA1956031Medicaid
5R449Medicare ID - Type Unspecified