Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 61841 | TN |
Y | 208600000X | Surgeon | 61841 | TN |
N | 208200000X | Surgeon | JS066015 | MI |
N | 208600000X | Surgeon | JS066015 | MI |
NPI | 1013087162 |
---|---|
Provider Name | Dr. Julie Ann Koffron |
First Address | Chattanooga, TN 37403-2187 |
Second Address | Chattanooga, TN 37404-2624 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2006 |
Last Update Date | 31/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4791469 | (05) | MI |
I45975 | (02) |