Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | MD23457 | TN |
NPI | 1003804808 |
---|---|
Provider Name | Dr. Paul J Gurecki |
First Address | Oak Ridge, TN 37830-6474 |
Second Address | Oak Ridge, TN 37830-6957 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2005 |
Last Update Date | 01/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3067777 | (05) | TN |
F29887 | (02) | TN |
P00311164 | RAILROAD MEDICARE (01) | TN |