Healthcare Provider Details

I. General information

NPI: 1992734057
Provider Name (Legal Business Name): STEPHEN BRET CHIPMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 07/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 PROFESSIONAL WAY
PAYSON UT
84651-1614
US

IV. Provider business mailing address

1055 N 500 W
PROVO UT
84604-3305
US

V. Phone/Fax

Practice location:
  • Phone: 801-465-4896
  • Fax: 801-465-4107
Mailing address:
  • Phone: 801-354-8225
  • Fax: 801-418-0941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5810651-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: