Provider Demographics
NPI:1528063252
Name:SIPES, RICHARD THOMAS (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:THOMAS
Last Name:SIPES
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 1:8625 LINE AVE STE E
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-6107
Mailing Address - Country:US
Mailing Address - Phone:318-935-6177
Mailing Address - Fax:888-935-4748
Practice Address - Street 1:8625 LINE AVE STE E
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-6107
Practice Address - Country:US
Practice Address - Phone:318-935-6177
Practice Address - Fax:888-935-4748
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13289R207RH0002X, 207R00000X, 207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA385661030DOtherBCBS
LA1578827Medicaid
LA1578827Medicaid
LA5H825BC11Medicare PIN