Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 0101239496 | VA |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | MD38613 | TN |
NPI | 1417973249 |
---|---|
Provider Name | Cory L Calendine |
First Address | Franklin, TN 37064-5526 |
Second Address | Franklin, TN 37067-5973 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 30/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0101239496 | VA LICENSE TO PRACTICE (01) | VA |
MD0000038613 | LICENSE TO PRACTICE (01) | TN |