MEDICARE: DR. KENT CHAPIN ELLIOTT MD

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	207Q00000X	Family Medicine Physician	G55836	CA
2	207Q00000X	Family Medicine Physician	12470	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11934121	OTHER		CAQH

General Provider Information

NPI Number	:	1235129198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENT CHAPIN ELLIOTT MD

Provider Business Mailing Address
First Line	:	780 KUENZLI ST
Second Line	:	SUITE 202
City	:	RENO
State	:	NV
Zip	:	89502-1011
Country	:	US
Telephone Number	:	775-982-4590
Fax Number	:	775-982-4595

Provider Business Practice Location Address
First Line	:	1075 N HILLS BLVD
Second Line	:	#180
City	:	RENO
State	:	NV
Zip	:	89506-5732
Country	:	US
Telephone Number	:	775-982-5000
Fax Number	:	775-982-6558

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

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	11/13/2009

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