Provider Demographics
NPI:1528326626
Name:JOHN D. ZIPPERER, JR., M.D., LLC
Entity type:Organization
Organization Name:JOHN D. ZIPPERER, JR., M.D., LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:ZIPPERER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:907-770-2606
Mailing Address - Street 1:12641 OLD GLENN HWY
Mailing Address - Street 2:101
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99508
Mailing Address - Country:US
Mailing Address - Phone:907-770-2606
Mailing Address - Fax:907-770-2604
Practice Address - Street 1:12641 OLD GLENN HWY
Practice Address - Street 2:101
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577
Practice Address - Country:US
Practice Address - Phone:907-770-2606
Practice Address - Fax:907-770-2604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-26
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1001937207RA0401X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Multi-Specialty