Provider Demographics
NPI:1598761702
Name:GIPE, PATRICK BRIAN (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:BRIAN
Last Name:GIPE
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 1:3346 PROFESSIONAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-4551
Mailing Address - Country:US
Mailing Address - Phone:270-685-1066
Mailing Address - Fax:270-685-0881
Practice Address - Street 1:3346 PROFESSIONAL PARK DR
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-4551
Practice Address - Country:US
Practice Address - Phone:270-685-1066
Practice Address - Fax:270-685-0881
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38029207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64079817Medicaid
0688304Medicare ID - Type Unspecified
KY64079817Medicaid