Basic Information
| Provider Information | |||||||||
| NPI: | 1881651685 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LIPSCOMB | ||||||||
| FirstName: | GARY | ||||||||
| MiddleName: | H. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 66 N PAULINE ST | ||||||||
| Address2: | SUITE 206 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381055105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9014487642 | ||||||||
| FaxNumber: | 9014488015 | ||||||||
| Practice Location | |||||||||
| Address1: | 1301 PRIMACY PKWY | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381190213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9018668812 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2006 | ||||||||
| LastUpdateDate: | 10/08/2018 | ||||||||
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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 | 207V00000X | 14222 | TN | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 00116300 | 05 | MS | MEDICAID | 115516001 | 05 | AR | MEDICAID | 1881651685 | 05 | AL | MEDICAID | 1881651685 | 05 | MO | MEDICAID | 003181954A | 05 | GA | MEDICAID | Q008592 | 05 | TN | MEDICAID | 3006841 | 05 | TN | MEDICAID |