Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | 6889 | NV |
NPI | 1154307320 |
---|---|
Provider Name | Dr. Phelps C Kip |
First Address | Reno, NV 89509-6158 |
Second Address | Reno, NV 89509-6158 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2005 |
Last Update Date | 02/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002016857 | (05) | NV |
11040852 | CAQH (01) | NV |
F24357 | (02) | NV |