Provider Demographics
NPI:1891759254
Name:JEPPSEN, ERNEST A (MD)
Entity Type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:A
Last Name:JEPPSEN
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 2651
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92263-2651
Mailing Address - Country:US
Mailing Address - Phone:760-288-4579
Mailing Address - Fax:760-288-3752
Practice Address - Street 1:19-531 MCLANE STREET
Practice Address - Street 2:SUITE B
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262
Practice Address - Country:US
Practice Address - Phone:760-288-4579
Practice Address - Fax:760-288-3752
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1497282084P0800X, 2084P2900X
CAC1705152084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C63279Medicare UPIN
00011984Medicare ID - Type UnspecifiedLAYTON
UT005580001Medicare PIN