Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 170100000X | Medical Geneticist | MD0000008020 | TN |
Y | 207R00000X | Internist | 8020 | TN |
Y | 111NI0900X | Internist | 8020 | TN |
NPI | 1124119458 |
---|---|
Provider Name | David Kenneth Fenner |
First Address | Elizabethton, TN 37643-2848 |
Second Address | Elizabethton, TN 37643-2848 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 17/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110147422 | RAILROAD MEDICARE (01) | TN |
202731 | BLUECARE (01) | TN |
202731 | BLUECROSS BLUESHIELD (01) | TN |
B03687 | (02) | TN |
P01302537 | RR MEDICARE (01) | TN |
Q002461 | (05) | TN |
TN0108 | AMERICHOICE (01) | TN |