Provider Demographics
NPI:1003874967
Name:KIPP, RICHARD J (DO)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:KIPP
Suffix:
Gender:M
Credentials:DO
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 328
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51102-0328
Mailing Address - Country:US
Mailing Address - Phone:712-279-5830
Mailing Address - Fax:712-279-5883
Practice Address - Street 1:3520 SINGING HILLS BLVD
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-5110
Practice Address - Country:US
Practice Address - Phone:712-294-7400
Practice Address - Fax:712-294-7436
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA02233207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA10025306900Medicaid
IA0479816Medicaid
IA02852OtherWELLMARK BCBS IA
IA10025306900Medicaid
A03406Medicare UPIN