Individual
DR. JACK OWENS SIPPERLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4800 N 22ND ST, PHOENIX, AZ 85016-4701
(602) 955-1000
(602) 508-4830
Mailing address
4800 N 22ND ST, PHOENIX, AZ 85016-4701
(602) 955-1000
(602) 508-4830
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
16167
AZ
207WX0107X
Retina Specialist (Ophthalmology) Physician
Primary
16167
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
285412
—
AZ
Enumeration date
08/10/2005
Last updated
05/07/2019
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