Provider Demographics
NPI:1487621132
Name:LIPPS, JACK MORGAN (MD)
Entity type:Individual
Prefix:DR
First Name:JACK
Middle Name:MORGAN
Last Name:LIPPS
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 1:6525 HOBSON ST. NE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-6922
Mailing Address - Country:US
Mailing Address - Phone:727-902-9400
Mailing Address - Fax:
Practice Address - Street 1:6525 HOBSON ST. NE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-6922
Practice Address - Country:US
Practice Address - Phone:727-902-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME38761207V00000X, 208D00000X
FLME038761207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL280479400Medicaid
FL62330OtherBLUE CROSS BLUE SHIELD
FL280479400Medicaid