Provider Demographics
NPI:1871690065
Name:PHIPPS, TIMOTHY D (DO)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:D
Last Name:PHIPPS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3800 S NATIONAL AVE
Mailing Address - Street 2:#540
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-5209
Mailing Address - Country:US
Mailing Address - Phone:417-269-6262
Mailing Address - Fax:417-269-4349
Practice Address - Street 1:700 E CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:MONETT
Practice Address - State:MO
Practice Address - Zip Code:65708-1436
Practice Address - Country:US
Practice Address - Phone:417-354-1520
Practice Address - Fax:417-354-1525
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO111073207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO245223607Medicaid
143154OtherBLUE CROSS OF MO
P00381626Medicare PIN
MO000095140Medicare PIN
H36219Medicare UPIN
20041216Medicare PIN
143154OtherBLUE CROSS OF MO