Provider Demographics
NPI:1023110871
Name:LIPSCOMB, JAMES WILLIE SR (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WILLIE
Last Name:LIPSCOMB
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:393 EAST TOWN STREET
Mailing Address - Street 2:SUITE 212
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215
Mailing Address - Country:US
Mailing Address - Phone:614-461-8383
Mailing Address - Fax:614-461-7760
Practice Address - Street 1:393 EAST TOWN STREET
Practice Address - Street 2:SUITE 212
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215
Practice Address - Country:US
Practice Address - Phone:614-461-8383
Practice Address - Fax:614-461-7760
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
9914261Medicare ID - Type Unspecified
B95422Medicare UPIN