Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 3511 | TN |
NPI | 1033112180 |
---|---|
Provider Name | Dr. Steven P Tipps |
First Address | Chattanooga, TN 37421-1688 |
Second Address | Chattanooga, TN 37421-1688 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2005 |
Last Update Date | 01/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0050858 | BCBSTN PROVDER NUMBER (01) | TN |
3225000 | (05) | TN |
4665225 | AETNA PROVIDER NUMBER (01) | TN |
T74390 | (02) | TN |