Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 07279 | TN |
NPI | 1578566519 |
---|---|
Provider Name | Dr. John A Spann |
First Address | Chattanooga, TN 37421-1688 |
Second Address | Chattanooga, TN 37421-1688 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2005 |
Last Update Date | 01/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3125604 | BCBSTN PROVIDER NUMBER (01) | TN |
3226438 | (05) | TN |
7745039 | AETNA PROVIDER NUMBER (01) | TN |
U74217 | (02) | TN |