Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 36.003539 | OH |
N | 222Z00000X | Podiatrist | 36.003539 | OH |
N | 213EP1101X | Primary Podiatric Medicine | 36.003539 | OH |
N | 2081S0010X | Sports Medicine | 36.003539 | OH |
N | 213ES0000X | Sports Medicine | 36.003539 | OH |
Y | 213ES0103X | Foot & Ankle Surgery | 36.003539 | OH |
N | 213ES0103X | Foot & Ankle Surgery | DPM0000000705 | TN |
N | 213ES0131X | Foot Surgery | 36.003539 | OH |
NPI | 1073764692 |
---|---|
Provider Name | Dr. Adam C Macevoy |
First Address | Bartlett, TN 38133-3986 |
Second Address | Bartlett, TN 38133-3986 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2008 |
Last Update Date | 17/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1526688 | (05) | TN |
36.003539 | STATE LICENSE (01) | OH |
DPM0000000705 | STATE LICENSE (01) | TN |