Provider Demographics
NPI:1952578452
Name:LIPPARD, WALTER KENNETH III (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:KENNETH
Last Name:LIPPARD
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:2150 E HIGHLAND AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4718
Mailing Address - Country:US
Mailing Address - Phone:602-266-8413
Mailing Address - Fax:602-266-1821
Practice Address - Street 1:2150 E HIGHLAND AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4718
Practice Address - Country:US
Practice Address - Phone:602-266-8413
Practice Address - Fax:602-266-1821
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2010-02-04
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Provider Licenses
StateLicense IDTaxonomies
AZ04579207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ250663Medicaid
AZ250663Medicaid
AZZ0000BBGLHMedicare PIN