Provider Demographics
NPI:1518989532
Name:LIPSCOMB, GARY EDWIN (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:EDWIN
Last Name:LIPSCOMB
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 1:1340 POYDRAS ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-1221
Mailing Address - Country:US
Mailing Address - Phone:504-568-6032
Mailing Address - Fax:504-568-6037
Practice Address - Street 1:2021 PERDIDO ST.
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-1221
Practice Address - Country:US
Practice Address - Phone:504-568-6032
Practice Address - Fax:504-568-6037
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA05123R207ZH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1334651Medicaid
LA5L195F668Medicare UPIN
LA5L195Medicare PIN
B61233Medicare UPIN
LA5L195F669Medicare PIN