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Individual
JOHN SISON TIPTON
Active
Individual
JOHN SISON TIPTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
200801219
NC
207QS0010X
Sports Medicine (Family Medicine) Physician
200801219
NC
208D00000X
General Practice Physician
11012608A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200886860
—
IN
05
—
5911711
—
NC
01
—
P00810774
RR MEDICARE
NC
Enumeration date
04/20/2007
Last updated
09/05/2013
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