Provider Demographics
NPI:1598702805
Name:DIPALMA, JACK A (MD)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:A
Last Name:DIPALMA
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 40480
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36640-0480
Mailing Address - Country:US
Mailing Address - Phone:251-660-5555
Mailing Address - Fax:251-660-5559
Practice Address - Street 1:75 S UNIVERSITY BLVD
Practice Address - Street 2:UCOM 6000 B
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36688-0002
Practice Address - Country:US
Practice Address - Phone:251-660-5555
Practice Address - Fax:251-660-5559
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13376207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000018497Medicaid
AL51018497OtherBLUE CROSS
AL29-10129OtherUNITED HEALTH CARE
MS00121712Medicaid
FL255601400Medicaid
AL000018497Medicaid
C73277Medicare UPIN
FL255601400Medicaid