Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 496 | MN |
Y | 222Z00000X | Podiatrist | 496 | MN |
N | 213ES0103X | Foot & Ankle Surgery | 496 | MN |
NPI | 1073561437 |
---|---|
Provider Name | Robert W Nipp |
First Address | Duluth, MN 55805 |
Second Address | Duluth, MN 55805 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 09/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5B969NO | BCBS (01) | |
634525500 | (05) | MN |
U40463 | (02) |