Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 035377 | TN |
NPI | 1033315064 |
---|---|
Provider Name | Dr. Ernesto Chioco |
First Address | Jackson, TN 38302-0400 |
Second Address | Humboldt, TN 38343-3639 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2007 |
Last Update Date | 15/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3868618 | (05) | TN |
F20397 | (02) |