Provider Demographics
NPI:1760724397
Name:TIPTON, DAVID ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ALLEN
Last Name:TIPTON
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:MAIL CODE: TA-A4A
Mailing Address - Street 2:
Mailing Address - City:KENNEDY SPACE CENTER
Mailing Address - State:FL
Mailing Address - Zip Code:32899
Mailing Address - Country:US
Mailing Address - Phone:321-867-6385
Mailing Address - Fax:321-867-3881
Practice Address - Street 1:BUILDING M7-0355
Practice Address - Street 2:ROOM 1116B
Practice Address - City:KENNEDY SPACE CENTER
Practice Address - State:FL
Practice Address - Zip Code:32899
Practice Address - Country:US
Practice Address - Phone:321-867-6385
Practice Address - Fax:321-867-3881
Is Sole Proprietor?:No
Enumeration Date:2013-03-21
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME41548207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine