Healthcare Provider Details

I. General information

NPI: 1902811300
Provider Name (Legal Business Name): ELLIOTT BRANSCOME NIPPER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 LOUISVILLE AVE
MONROE LA
71201
US

IV. Provider business mailing address

1501 LOUISVILLE AVE
MONROE LA
71201-6025
US

V. Phone/Fax

Practice location:
  • Phone: 318-323-8451
  • Fax: 318-361-2613
Mailing address:
  • Phone: 318-323-8451
  • Fax: 318-361-2613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number20054
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number305504
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: