Provider Demographics
NPI:1457493967
Name:CHIPMAN, GREGORY CARL (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:CARL
Last Name:CHIPMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1121 E 3900 S
Mailing Address - Street 2:STE C240
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1214
Mailing Address - Country:US
Mailing Address - Phone:801-262-9494
Mailing Address - Fax:801-262-0507
Practice Address - Street 1:48 N 1100 E
Practice Address - Street 2:STE B
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2910
Practice Address - Country:US
Practice Address - Phone:801-492-9934
Practice Address - Fax:801-492-9936
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO47737207RH0003X
UT7801558207RH0003X
UT7801558-1205207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO71808817Medicaid
UTU000078538Medicare PIN
CO71808817Medicaid