Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 61833 | TN |
N | 208200000X | Surgeon | 61833 | TN |
N | 208600000X | Surgeon | 61833 | TN |
N | 2086S0102X | Surgical Critical Care | 036090432 | IL |
NPI | 1124056726 |
---|---|
Provider Name | Alan Joseph Koffron |
First Address | Chattanooga, TN 37403-2187 |
Second Address | Chattanooga, TN 37404-2624 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2006 |
Last Update Date | 03/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036090432 | (05) | IL |
H46323 | (02) |