Provider Demographics
NPI:1295773737
Name:TIPPETS, WILLIAM (DO, MBA)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:TIPPETS
Suffix:
Gender:M
Credentials:DO, MBA
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 8500 LOCKBOX 7642
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-7642
Mailing Address - Country:US
Mailing Address - Phone:813-281-8115
Mailing Address - Fax:813-281-8656
Practice Address - Street 1:911 W. 5TH AVE.
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204
Practice Address - Country:US
Practice Address - Phone:509-455-7844
Practice Address - Fax:509-623-0415
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0062904207L00000X, 207LP2900X
MDDH0062904207LP3000X
WAOP60744732207LP3000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4083466Medicaid
MDCA8702Medicare PIN
MDI36607Medicare UPIN
MDL966Medicare PIN
MD4083466Medicaid
MDL966Medicare ID - Type Unspecified
MDL965Medicare PIN