Basic Information
| Provider Information | |||||||||
| NPI: | 1598702805 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DIPALMA | ||||||||
| FirstName: | JACK | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 40480 | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366400480 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2516605555 | ||||||||
| FaxNumber: | 2516605559 | ||||||||
| Practice Location | |||||||||
| Address1: | 75 S UNIVERSITY BLVD | ||||||||
| Address2: | UCOM 6000 B | ||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366880002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2516605555 | ||||||||
| FaxNumber: | 2516605559 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2006 | ||||||||
| LastUpdateDate: | 05/11/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 13376 | AL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 000018497 | 05 | AL | MEDICAID | 51018497 | 01 | AL | BLUE CROSS | OTHER | 29-10129 | 01 | AL | UNITED HEALTH CARE | OTHER | 00121712 | 05 | MS | MEDICAID | 255601400 | 05 | FL | MEDICAID |