Provider Demographics
NPI:1942297973
Name:LIPPMAN, BRIAN A (PA)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:A
Last Name:LIPPMAN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 N HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33755-2138
Mailing Address - Country:US
Mailing Address - Phone:727-442-3001
Mailing Address - Fax:727-467-9106
Practice Address - Street 1:1840 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33755-2138
Practice Address - Country:US
Practice Address - Phone:727-442-3001
Practice Address - Fax:727-467-9106
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9100950363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL290946400Medicaid
FL970013098OtherRAILROAD MEDICARE
FLR32942Medicare ID - Type Unspecified
FL970013098OtherRAILROAD MEDICARE