Evan Shipp
Dentist - General Practice Oral and Maxillofacial Surgeon
1100 Wilford Hall Loop Bldg 4554
Jbsa Lackland
, Texas 78236-5638
Evan Shipp
Dentist - General Practice Oral and Maxillofacial Surgeon
1100 Wilford Hall Loop Bldg 4554
Jbsa Lackland
, Texas 78236-5638
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About
Features
Specialties
- General Practice
- Oral and Maxillofacial Surgeon
Languages spoken
- English
Location
First Address
- Evan Shipp
- 1100 Wilford Hall Loop Bldg 4554
- Jbsa Lackland, TX
- Zip : 78236-5638
- Phone :
Second Address
- Evan Shipp
- 1100 Wilford Hall Loop Bldg 4554
- Jbsa Lackland, TX
- Zip : 78236-5638
- Phone : (512) 621-5529
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| N | 1223G0001X | General Practice | 61852 | CA |
| N | 213EG0000X | General Practice | 61852 | CA |
| Y | 1223S0112X | Oral and Maxillofacial Surgeon | 35986 | TX |
National Provider Identifier
| NPI | 1023378999 |
|---|---|
| Provider Name | Evan Shipp |
| First Address | Jbsa Lackland, TX 78236-5638 |
| Second Address | Jbsa Lackland, TX 78236-5638 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 24/05/2012 |
| Last Update Date | 22/07/2020 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.