Basic Information
Provider Information
NPI: 1487745170
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GIPPS
FirstName: PAUL
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7200 CORPORATE CENTER DR
Address2: SUITE 600
City: MIAMI
State: FL
PostalCode: 331261200
CountryCode: US
TelephoneNumber: 3055002000
FaxNumber: 3055002080
Practice Location
Address1: 8608 BIRD RD
Address2:  
City: MIAMI
State: FL
PostalCode: 331553216
CountryCode: US
TelephoneNumber: 3055513200
FaxNumber: 3052221713
Other Information
ProviderEnumerationDate: 09/27/2006
LastUpdateDate: 05/10/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/10/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XME87199FLY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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