Provider Demographics
NPI:1053367383
Name:LIPMAN, BRIAN JONATHAN (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:JONATHAN
Last Name:LIPMAN
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:PO BOX 845712
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90084-5712
Mailing Address - Country:US
Mailing Address - Phone:888-252-2804
Mailing Address - Fax:702-444-2149
Practice Address - Street 1:10001 S EASTERN AVE STE 307
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052
Practice Address - Country:US
Practice Address - Phone:702-909-7170
Practice Address - Fax:702-909-7234
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9172207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2018176Medicaid
E44639Medicare UPIN
V32283Medicare ID - Type Unspecified