Provider Demographics
NPI:1013917988
Name:LIPSCOMB, LARRY BERNARD (MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:BERNARD
Last Name:LIPSCOMB
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 1:19916 GEMSTONE DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77356-4937
Mailing Address - Country:US
Mailing Address - Phone:281-467-7840
Mailing Address - Fax:
Practice Address - Street 1:10850 LOUETTA RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-3533
Practice Address - Country:US
Practice Address - Phone:281-320-2338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5303207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX135361703Medicaid
TX135361703Medicaid