Individual
MR. JOSEPH W IPPOLITO JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
526 SHOUP AVE W, SUITE F, TWIN FALLS, ID 83301-6050
(208) 736-7620
(208) 735-9537
Mailing address
526 SHOUP AVE W, SUITE F, TWIN FALLS, ID 83301-5050
(208) 736-7620
(208) 735-9537
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M7008
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010001696
REGENCE BLUE SHIELD OF ID
ID
05
—
003755600
—
ID
01
—
DY066
BLUE CROSS OF IDAHO
ID
Enumeration date
07/15/2006
Last updated
11/23/2021
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