Provider Demographics
NPI:1851371769
Name:IPSEN, BRIAN J (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:J
Last Name:IPSEN
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:PO BOX 2546
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803-2546
Mailing Address - Country:US
Mailing Address - Phone:620-783-4444
Mailing Address - Fax:620-783-4090
Practice Address - Street 1:444 FOUR STATES DR
Practice Address - Street 2:STE 1
Practice Address - City:GALENA
Practice Address - State:KS
Practice Address - Zip Code:66379-4325
Practice Address - Country:US
Practice Address - Phone:620-783-4444
Practice Address - Fax:620-783-4090
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000164182207XS0117X
KS04-29574207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207327206Medicaid
KS20033009FMedicaid
MO207327206Medicaid
KS20033009FMedicaid
MO933015141Medicare PIN