Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | 020056 | TN |
NPI | 1275543993 |
---|---|
Provider Name | Dr. Karsten Gammeltoft |
First Address | Knoxville, TN 37916-2219 |
Second Address | Knoxville, TN 37916-2219 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0198445 | BLUE CROSS (01) | TN |
198445 | (05) | TN |
E91322 | (02) | TN |