Provider Demographics
NPI:1831344050
Name:DONALD W. DIPPE MD A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:DONALD W. DIPPE MD A PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:DIPPE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-264-1405
Mailing Address - Street 1:2841 DEBARR RD
Mailing Address - Street 2:SUITE 35
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-2967
Mailing Address - Country:US
Mailing Address - Phone:907-264-1405
Mailing Address - Fax:907-264-1404
Practice Address - Street 1:2841 DEBARR RD
Practice Address - Street 2:SUITE 35
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2967
Practice Address - Country:US
Practice Address - Phone:907-264-1405
Practice Address - Fax:907-264-1404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-02
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1495207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD1495Medicaid
KKI0000BHJKDMedicare PIN
AKMD1495Medicaid