Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | 53464 | TN |
NPI | 1336248996 |
---|---|
Provider Name | Dr. Mj Hajianpour |
First Address | Mountain Home, TN 37684-0699 |
Second Address | Johnson City, TN 37604-6056 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2006 |
Last Update Date | 09/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A483500 | (05) | CA |
37614470 | TN GROUP MEDICARE (01) | TN |
A48350 | MEDICAL LICENSE NUMBER (01) | CA |
E61610 | (02) | CA |