Provider Demographics
NPI:1548366768
Name:TIPTON, ANCEL C (MD)
Entity type:Individual
Prefix:DR
First Name:ANCEL
Middle Name:C
Last Name:TIPTON
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 1:971 LAKELAND DR
Mailing Address - Street 2:SUITE 557
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4643
Mailing Address - Country:US
Mailing Address - Phone:601-362-1577
Mailing Address - Fax:601-368-9394
Practice Address - Street 1:971 LAKELAND DR
Practice Address - Street 2:STE 1060
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4609
Practice Address - Country:US
Practice Address - Phone:601-362-1577
Practice Address - Fax:601-368-9394
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS051632084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS12670Medicaid
MSB29996Medicare UPIN
MS132616726Medicare ID - Type Unspecified