Provider Demographics
NPI:1689641953
Name:LIPPERT, WILLIAM L III (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:L
Last Name:LIPPERT
Suffix:III
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 1:6011 E WOODMEN RD
Mailing Address - Street 2:SUITE 365
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-2606
Mailing Address - Country:US
Mailing Address - Phone:719-380-7246
Mailing Address - Fax:719-380-8282
Practice Address - Street 1:6011 E WOODMEN RD
Practice Address - Street 2:SUITE 365
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-2606
Practice Address - Country:US
Practice Address - Phone:719-380-7246
Practice Address - Fax:719-380-8282
Is Sole Proprietor?:No
Enumeration Date:2006-03-04
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO25034207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01250349Medicaid
CO050047444OtherRAILROAD MEDICARE NUMBER
CO01250349Medicaid
COD24557Medicare UPIN