Provider Demographics
NPI:1235129198
Name:ELLIOTT, KENT CHAPIN (MD)
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:CHAPIN
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:780 KUENZLI ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1011
Mailing Address - Country:US
Mailing Address - Phone:775-982-4590
Mailing Address - Fax:775-982-4595
Practice Address - Street 1:1075 N HILLS BLVD
Practice Address - Street 2:#180
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89506-5732
Practice Address - Country:US
Practice Address - Phone:775-982-5000
Practice Address - Fax:775-982-6558
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2009-11-13
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Provider Licenses
StateLicense IDTaxonomies
CAG55836207Q00000X
NV12470207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
11934121OtherCAQH
11934121OtherCAQH