Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 54732 | TN |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 54732 | TN |
NPI | 1972739654 |
---|---|
Provider Name | Dr. Kevin Michael Dale |
First Address | Nashville, TN 37232-5100 |
Second Address | Nashville, TN 37232-5100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2009 |
Last Update Date | 15/10/2020 |