Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 38448 | TN |
Y | 207ND0101X | MOHS-Micrographic Surgeon | 38448 | TN |
NPI | 1043278336 |
---|---|
Provider Name | Dr. Matthew C Hanggi |
First Address | Knoxville, TN 37922-3369 |
Second Address | Knoxville, TN 37922-3369 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2006 |
Last Update Date | 05/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3896989 | (05) | TN |
4084413 | BLUE CROSS (01) | TN |
7807328 | AETNA (01) | TN |
H56592 | (02) | TN |