Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | PD 1980 | MA |
Y | 222Z00000X | Podiatrist | PD 1980 | MA |
N | 213EP1101X | Primary Podiatric Medicine | PD 1980 | MA |
N | 111NR0200X | Radiology | PD 1980 | MA |
N | 213ER0200X | Radiology | PD 1980 | MA |
N | 2081S0010X | Sports Medicine | PD 1980 | MA |
N | 213ES0000X | Sports Medicine | PD 1980 | MA |
N | 213ES0103X | Foot & Ankle Surgery | PD 1980 | MA |
NPI | 1346231453 |
---|---|
Provider Name | Dr. Craig Stewart Tenzer |
First Address | Foxboro, MA 02035-5212 |
Second Address | Fall River, MA 02720-5246 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2005 |
Last Update Date | 15/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
043282327 | TAX IDENTIFICATION NUMBER (01) | MA |
U34024 | (02) | MA |
Y70957 | BLUE CROSS & BLUE SHIELD (01) | MA |