Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 30444 | TN |
N | 208000000X | Pediatrician | MD30444 | TN |
Y | 2080P0204X | Pediatric Emergency Doctor | MD30444 | TN |
NPI | 1043246879 |
---|---|
Provider Name | Dr. John R. Carder |
First Address | Knoxville, TN 37932-1984 |
Second Address | Knoxville, TN 37916-2301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2006 |
Last Update Date | 08/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3097696 | BLUE CROSS (01) | TN |
3897179 | (05) | TN |
64720006 | (05) | KY |