Provider Demographics
NPI:1891929063
Name:CHIP, JEROLD NORMAN I (MD)
Entity Type:Individual
Prefix:
First Name:JEROLD
Middle Name:NORMAN
Last Name:CHIP
Suffix:I
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1395 NW 167TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-5742
Mailing Address - Country:US
Mailing Address - Phone:305-831-4761
Mailing Address - Fax:305-831-4761
Practice Address - Street 1:206 N FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-4902
Practice Address - Country:US
Practice Address - Phone:863-209-7003
Practice Address - Fax:863-284-3083
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-04
Last Update Date:2017-02-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01019735A207RC0000X
MI4301094726207R00000X
FLME123575207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine