Provider Demographics
NPI:1811041569
Name:LIPPMANN, RONALD DEAN (DO)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:DEAN
Last Name:LIPPMANN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:RON
Other - Middle Name:
Other - Last Name:LIPPMANN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:D O PA
Mailing Address - Street 1:2381 MASON AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117
Mailing Address - Country:US
Mailing Address - Phone:321-207-9029
Mailing Address - Fax:844-410-7960
Practice Address - Street 1:2381 MASON AVE
Practice Address - Street 2:STE 100
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117
Practice Address - Country:US
Practice Address - Phone:321-207-9029
Practice Address - Fax:844-410-7960
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7517208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
62906XMedicare PIN
I41214Medicare UPIN