Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | DC0000001465 | TN |
NPI | 1215969845 |
---|---|
Provider Name | Dr. John L. Burley |
First Address | Joelton, TN 37080 |
Second Address | Joelton, TN 37080 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4056858 | BLUECROSS BLUESHIELD (01) | TN |
4402093 | MEDICARE COMPLETE (01) | TN |
6850315 | CIGNA (01) | TN |