Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | DO-2027 | TN |
N | 207R00000X | Internist | DO-2027 | TN |
N | 111NI0900X | Internist | DO-2027 | TN |
N | 207R00000X | Internist | DO-941 | AL |
N | 111NI0900X | Internist | DO-941 | AL |
Y | 207R00000X | Internist | DO2027 | TN |
Y | 111NI0900X | Internist | DO2027 | TN |
N | 207RH0002X | Hospice and Palliative Medicine | DO-2027 | TN |
N | 208000000X | Pediatrician | DO-941 | AL |
N | 208000000X | Pediatrician | DO2027 | TN |
NPI | 1073603411 |
---|---|
Provider Name | Dr. Christopher Shea Burress |
First Address | Bon Aqua, TN 37025-1764 |
Second Address | Bon Aqua, TN 37025-1764 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2006 |
Last Update Date | 15/02/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11777708 | CAQH (01) | TN |
1522546 | (05) | TN |
171777 | (02) | AL |