Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RG0100X | Gastroenterologist | 0101051162 | VA |
Y | 207RG0100X | Gastroenterologist | MD25581 | TN |
NPI | 1043213101 |
---|---|
Provider Name | Dr. Dallas Shone |
First Address | Kingsport, TN 37662-0009 |
Second Address | Kingsport, TN 37660-3256 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2005 |
Last Update Date | 07/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
006011527 | (05) | VA |
103I086169 | (02) | TN |
1513713 | (05) | TN |
3084190 | (05) | TN |
3700592 | (02) | TN |
6011527 | (05) | VA |
F13414 | (02) |