Provider Demographics
NPI:1578777538
Name:HASE-LIPTON, VIVIAN RUTH (MD)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:RUTH
Last Name:HASE-LIPTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VIVIAN
Other - Middle Name:RUTH
Other - Last Name:GILES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:724 N SPRING ST STE A
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-2913
Mailing Address - Country:US
Mailing Address - Phone:870-365-0850
Mailing Address - Fax:870-365-0862
Practice Address - Street 1:724 N SPRING ST STE A
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-2913
Practice Address - Country:US
Practice Address - Phone:870-365-0850
Practice Address - Fax:870-365-0862
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6120783-3400175M00000X
TXBP10056154207Q00000X
ARE-15623207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No175M00000XOther Service ProvidersMidwife, Lay