Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | DPM338 | TN |
Y | 222Z00000X | Podiatrist | DPM338 | TN |
NPI | 1053398107 |
---|---|
Provider Name | Dr. James Arthur Engblom |
First Address | Knoxville, TN 37922-3355 |
Second Address | Oak Ridge, TN 37830-6474 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2005 |
Last Update Date | 02/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3351783 | (05) | TN |
480026064 | RAILROAD MEDICARE (01) | TN |
6035392 | BCBS TN (01) | TN |
T97948 | (02) |