Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 0101254748 | VA |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 0101254748 | VA |
NPI | 1225303043 |
---|---|
Provider Name | David Jackson Tennent |
First Address | Ft Carson, CA 80913 |
Second Address | Colorado Springs, CO 80913 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2012 |
Last Update Date | 02/07/2019 |