Provider Demographics
NPI:1932744158
Name:WHIPPO, BRIAN J (PA-C)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:J
Last Name:WHIPPO
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:933 BRADBURY DR SE STE 2222
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4375
Mailing Address - Country:US
Mailing Address - Phone:505-272-3120
Mailing Address - Fax:505-272-8060
Practice Address - Street 1:1 UNIVERSITY OF NEW MEXICO
Practice Address - Street 2:MSC 10-8000
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106
Practice Address - Country:US
Practice Address - Phone:505-272-5062
Practice Address - Fax:505-925-7290
Is Sole Proprietor?:No
Enumeration Date:2019-11-12
Last Update Date:2024-01-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NMPA2019-0102363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical