MEDICARE: DR. ERNEST W CHUPP M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	15346	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073564779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERNEST W CHUPP M.D.

Provider Business Mailing Address
First Line	:	7710 MERCY RD
Second Line	:	422
City	:	OMAHA
State	:	NE
Zip	:	68124-2372
Country	:	US
Telephone Number	:	402-392-0735
Fax Number	:	402-392-0229

Provider Business Practice Location Address
First Line	:	7710 MERCY RD
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68124-2372
Country	:	US
Telephone Number	:	402-392-0735
Fax Number	:	402-392-0229

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	02/26/2013

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