Provider Demographics
NPI:1457379398
Name:SHIPP, BERNARD LORING (MD)
Entity Type:Individual
Prefix:
First Name:BERNARD
Middle Name:LORING
Last Name:SHIPP
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 1:3302C W LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-9119
Mailing Address - Country:US
Mailing Address - Phone:662-286-6068
Mailing Address - Fax:662-286-0188
Practice Address - Street 1:3302C W LINDEN ST
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-9119
Practice Address - Country:US
Practice Address - Phone:662-286-6068
Practice Address - Fax:662-286-0188
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS06029207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00015611Medicaid
MS00015611Medicaid
B30405Medicare UPIN