Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 4301095474 | MI |
N | 111NI0900X | Internist | 4301095474 | MI |
Y | 207RN0300X | Nephrologist | 4301095474 | MI |
N | 208000000X | Pediatrician | 4301095474 | MI |
N | 2080P0210X | Pediatric Nephrologist | 9900843 | NC |
NPI | 1144231531 |
---|---|
Provider Name | Patrick Evan Gipson |
First Address | Ann Arbor, MI 48108-1633 |
Second Address | Ann Arbor, MI 48109-5000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2006 |
Last Update Date | 26/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
891246Y | (05) | NC |
F54324 | (02) | MI |
F54324 | (02) | NC |