Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 2083 | TN |
NPI | 1154324804 |
---|---|
Provider Name | Dr. Wayne E 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 | 25/05/2005 |
Last Update Date | 01/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2004791 | BCBSTN PROVIDER NUMBER (01) | TN |
3215429 | (05) | TN |
4665595 | AETNA PROVIDER NUMBER (01) | TN |
T74223 | (02) | TN |