Provider Demographics
NPI:1841442761
Name:LIPSON, JOHN HANNEGAN (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HANNEGAN
Last Name:LIPSON
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1430 FREEDOM BLVD
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-2780
Mailing Address - Country:US
Mailing Address - Phone:831-763-8400
Mailing Address - Fax:831-763-8237
Practice Address - Street 1:1430 FREEDOM BLVD
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-2780
Practice Address - Country:US
Practice Address - Phone:831-763-8400
Practice Address - Fax:831-763-8237
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-22
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA105468207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine