Basic Information
| Provider Information | |||||||||
| NPI: | 1770526485 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TIPTON | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6801 DIXIE HWY | ||||||||
| Address2: | SUITE 134 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402583913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5024474500 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6801 DIXIE HWY | ||||||||
| Address2: | SUITE 134 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402583913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5024474500 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2006 | ||||||||
| LastUpdateDate: | 12/22/2008 | ||||||||
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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 | 213ES0103X | 00133 | KY | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
ID Information
| ID | Type | State | Issuer | Description | 000000047475 | 01 | KY | ANTHEM BCBS ID # | OTHER | 610992425 | 01 | KY | HUMANA ID # | OTHER | 610992425 | 01 | KY | CIGNA ID # | OTHER | 80001332 | 05 | KY | MEDICAID |