Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | C38640 | CA |
NPI | 1073524740 |
---|---|
Provider Name | Bradley Elliott Chipps |
First Address | Roseville, CA 95661-4051 |
Second Address | Sacramento, CA 95819 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2006 |
Last Update Date | 11/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A36971 | (02) | CA |