Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | MD0000019805 | TN |
NPI | 1043210164 |
---|---|
Provider Name | Dr. Eric R Nicely |
First Address | Knoxville, TN 37922-3347 |
Second Address | Powell, TN 37849-3558 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2005 |
Last Update Date | 07/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1669416442 | GROUP NPI (01) | TN |
3084254 | (05) | TN |
3106070 | BLUE CROSS (01) | TN |
3106086 | BLUE CROSS (01) | TN |
CI2260 | RAILROAD MEDICARE (01) | TN |
F81254 | (02) | TN |