MEDICARE: GREGORY J VIPOND 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	207YX0007X	Plastic Surgery within the Head & Neck (Otolaryngology) Physician	A100020	CA
2	207YX0905X	Otolaryngology/Facial Plastic Surgery Physician	A100020	CA
3	207YS0123X	Facial Plastic Surgery Physician	A100020	CA

General Provider Information

NPI Number	:	1750590188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY J VIPOND M.D.

Provider Business Mailing Address
First Line	:	1601 MONTE VISTA AVE
Second Line	:	SUITE 200
City	:	CLAREMONT
State	:	CA
Zip	:	91711-2962
Country	:	US
Telephone Number	:	909-608-7770
Fax Number	:	909-931-7411

Provider Business Practice Location Address
First Line	:	1601 MONTE VISTA AVE
Second Line	:	SUITE 200
City	:	CLAREMONT
State	:	CA
Zip	:	91711-2962
Country	:	US
Telephone Number	:	909-608-7770
Fax Number	:	909-931-7411

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

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	09/04/2014

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Directions to “ GREGORY J VIPOND M.D.” Practice Location

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