Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 0000006167 | TN |
NPI | 1801847025 |
---|---|
Provider Name | Dr. John Richard Janovich |
First Address | Memphis, TN 38134-3104 |
Second Address | Covington, TN 38019-3635 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 20/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3153325 | (05) | TN |
B02459 | (02) | TN |