Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | 61136 | TN |
N | 2080P0203X | Pediatric Critical Care Doctor | R3342 | TX |
NPI | 1275979668 |
---|---|
Provider Name | Dustin Michael Hipp |
First Address | Nashville, TN 37204-4701 |
Second Address | Nashville, TN 37232-2608 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2013 |
Last Update Date | 02/12/2020 |