Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 0000004920 | TN |
NPI | 1003950205 |
---|---|
Provider Name | Dr. Dustin J Flowers |
First Address | Hohenwald, TN 38462-1355 |
Second Address | Hohenwald, TN 38462-1355 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0000004920 | OPERATING LICENSE (01) | TN |