Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | MD0000018930 | TN |
NPI | 1033144381 |
---|---|
Provider Name | Charles G Dye |
First Address | Oak Ridge, TN 37830 |
Second Address | Oak Ridge, TN 37830 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3036321 | (05) | TN |
48708 | BLUE CROSS BLUE SHIELD (01) | TN |
A99980 | (02) |