Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0000X | Hematologist | MD47141 | TN |
Y | 2080P0207X | Pediatric Hematology-Oncologist | 47141 | TN |
NPI | 1043238850 |
---|---|
Provider Name | Dr. Michael R Debaun |
First Address | Nashville, TN 37204-4701 |
Second Address | Nashville, TN 37232 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 15/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1523889 | (05) | TN |
F41413 | (02) |