Provider Demographics
NPI:1790748515
Name:LIPSCOMB, JEANNE POOLE (MD)
Entity Type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:POOLE
Last Name:LIPSCOMB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1406 MCFARLAND BLVD N
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-2293
Mailing Address - Country:US
Mailing Address - Phone:205-343-0004
Mailing Address - Fax:205-343-0092
Practice Address - Street 1:1406 MCFARLAND BLVD N
Practice Address - Street 2:SUITE 1C
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-2293
Practice Address - Country:US
Practice Address - Phone:205-343-0004
Practice Address - Fax:205-343-0092
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL18924207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000025330Medicare ID - Type Unspecified
ALF91937Medicare UPIN