Provider Demographics
NPI:1790770717
Name:LIPPAS, MATTHEW DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:DANIEL
Last Name:LIPPAS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8144 WALNUT HILL LN
Mailing Address - Street 2:SUITE 448
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4388
Mailing Address - Country:US
Mailing Address - Phone:214-369-3433
Mailing Address - Fax:214-369-0636
Practice Address - Street 1:8144 WALNUT HILL LN
Practice Address - Street 2:SUITE 448
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4388
Practice Address - Country:US
Practice Address - Phone:214-369-3433
Practice Address - Fax:214-369-0636
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG6740207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC18457Medicare UPIN
TX0010AYMedicare ID - Type Unspecified