Individual
GROVER GENE SHIPMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
914 PINE STREET, MOUNT SHASTA, CA 96067-2143
(530) 926-6111
Mailing address
P.O. BOX 12259, WESTMINSTER, CA 92685-2259
(888) 634-8405
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD25595
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A967380
—
CA
Enumeration date
09/06/2006
Last updated
07/02/2008
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