Provider Demographics
NPI:1538130109
Name:HIPKIN, DAVID (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:HIPKIN
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:PO BOX 790
Mailing Address - Street 2:
Mailing Address - City:PAGE
Mailing Address - State:AZ
Mailing Address - Zip Code:86040-0790
Mailing Address - Country:US
Mailing Address - Phone:928-645-0945
Mailing Address - Fax:928-645-2364
Practice Address - Street 1:463 S. LAKE POWELL BLVD
Practice Address - Street 2:
Practice Address - City:PAGE
Practice Address - State:AZ
Practice Address - Zip Code:86040-0790
Practice Address - Country:US
Practice Address - Phone:928-645-0945
Practice Address - Fax:928-645-2364
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21930207Q00000X
NV11352207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVP00240629OtherRAILROAD MEDICARE
NV100505853Medicaid
NV100505857Medicaid
AZ157588Medicaid
NVV100433OtherMEDICARE REVALIDATION
NV100505857Medicaid
NVV100433OtherMEDICARE REVALIDATION