Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 14502 | TN |
Y | 207VG0400X | Gynecologist | 14502 | TN |
NPI | 1114984010 |
---|---|
Provider Name | Dr. Michael R Caudle |
First Address | Talbott, TN 37877-8605 |
Second Address | Knoxville, TN 37921-5718 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2006 |
Last Update Date | 28/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B04763 | (02) |