Provider Demographics
NPI:1184610818
Name:LIPORACE, DAVID L (DO)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:L
Last Name:LIPORACE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:580 VILLAGE BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-1904
Mailing Address - Country:US
Mailing Address - Phone:561-688-5030
Mailing Address - Fax:561-688-9565
Practice Address - Street 1:580 VILLAGE BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-1904
Practice Address - Country:US
Practice Address - Phone:561-688-5030
Practice Address - Fax:561-688-9565
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS5607207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE40691Medicare UPIN
FL80142Medicare ID - Type Unspecified