Provider Demographics
NPI:1639137326
Name:SHIPLE, BRIAN J (DO)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:J
Last Name:SHIPLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:525 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-2430
Mailing Address - Country:US
Mailing Address - Phone:302-472-3634
Mailing Address - Fax:302-224-2848
Practice Address - Street 1:905 W SPROUL RD
Practice Address - Street 2:SUITE 106
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-1254
Practice Address - Country:US
Practice Address - Phone:484-472-8812
Practice Address - Fax:484-472-8878
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS077302-E207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E80440Medicare UPIN
PA163913Medicare UPIN
DE000364N51Medicare ID - Type Unspecified