Provider Demographics
NPI:1578780201
Name:TIPTON, JOHN SISON (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:SISON
Last Name:TIPTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1701 WESTCHESTER DRIVE
Mailing Address - Street 2:SUITE 850
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-7254
Mailing Address - Country:US
Mailing Address - Phone:336-802-2400
Mailing Address - Fax:336-802-2534
Practice Address - Street 1:611 N LINDSAY ST
Practice Address - Street 2:SUITE 200
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-4300
Practice Address - Country:US
Practice Address - Phone:336-802-2350
Practice Address - Fax:336-802-2351
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC200801219207QS0010X, 207Q00000X
IN11012608A208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200886860Medicaid
NCP00810774OtherRR MEDICARE
NC5911711Medicaid
NC2073835Medicare PIN