Provider Demographics
NPI:1639163181
Name:HIPP, JAN E (MD)
Entity Type:Individual
Prefix:MRS
First Name:JAN
Middle Name:E
Last Name:HIPP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 REMINGTON PLZ
Mailing Address - Street 2:
Mailing Address - City:RAYMORE
Mailing Address - State:MO
Mailing Address - Zip Code:64083-8588
Mailing Address - Country:US
Mailing Address - Phone:816-318-1725
Mailing Address - Fax:816-318-1189
Practice Address - Street 1:1118 REMINGTON PLZ
Practice Address - Street 2:
Practice Address - City:RAYMORE
Practice Address - State:MO
Practice Address - Zip Code:64083-8584
Practice Address - Country:US
Practice Address - Phone:816-318-1725
Practice Address - Fax:816-318-1189
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004017634207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208436915Medicaid
I16754Medicare UPIN
MOS28D353Medicare ID - Type Unspecified