Provider Demographics
NPI:1821135153
Name:LIPTON, DENNIS JAY (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:JAY
Last Name:LIPTON
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 1:28 2ND ST STE 216
Mailing Address - Street 2:
Mailing Address - City:EDWARDS
Mailing Address - State:CO
Mailing Address - Zip Code:81632-8137
Mailing Address - Country:US
Mailing Address - Phone:970-446-5050
Mailing Address - Fax:970-289-9017
Practice Address - Street 1:28 2ND ST STE 216
Practice Address - Street 2:
Practice Address - City:EDWARDS
Practice Address - State:CO
Practice Address - Zip Code:81632-8137
Practice Address - Country:US
Practice Address - Phone:970-446-5050
Practice Address - Fax:970-289-9017
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9801357207R00000X
CO52534207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891179HMedicaid
NC891179HMedicaid
G85676Medicare UPIN