Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | DS1305 | TN |
NPI | 1891784575 |
---|---|
Provider Name | Dr. Fenton P. Hardison |
First Address | Murfreesboro, TN 37130-2468 |
Second Address | Murfreesboro, TN 37130-2468 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T81651 | (02) | TN |