Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 59378 | TN |
NPI | 1023490281 |
---|---|
Provider Name | Bobby W Douglas |
First Address | Knoxville, TN 37920-4359 |
Second Address | Morristown, TN 37814 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2015 |
Last Update Date | 22/06/2020 |