MEDICARE: HOWARD N CHIPMAN III 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	207Q00000X	Family Medicine Physician	ME0050526	FL

General Provider Information

NPI Number	:	1417956293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOWARD N CHIPMAN III M.D.

Provider Business Mailing Address
First Line	:	3705 TAMPA RD
Second Line	:	STE 22
City	:	OLDSMAR
State	:	FL
Zip	:	34677-6300
Country	:	US
Telephone Number	:	813-891-6343
Fax Number	:	813-891-6342

Provider Business Practice Location Address
First Line	:	3705 TAMPA RD
Second Line	:	STE 22
City	:	OLDSMAR
State	:	FL
Zip	:	34677-6300
Country	:	US
Telephone Number	:	813-891-6343
Fax Number	:	813-891-6342

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

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	07/09/2007

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