| Doctor Name: | DR. JACK MORGAN LIPPS |
| NPI Number: | 1487621132 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | ME38761 |
| Business Practice Address: | 4202 E Fowler Ave Shs 100 Tampa, FL - 336206750 |
| Business Phone Number: | 8139742331 |
| Business Fax Number: | |
| Mailing Address: | Po Box 917770, ORLANDO |
| State: | FL |
| Postal Code: | 328917770 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 03/01/2006 |
| NPI Last Update Date: | 02/19/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | ME38761 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | FL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |