Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 39362 | TN |
NPI | 1144290834 |
---|---|
Provider Name | Dr. John A Dorizas |
First Address | Chattanooga, TN 37403-2136 |
Second Address | Chattanooga, TN 37403-2136 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2006 |
Last Update Date | 28/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I12790 | (02) |