Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | MD18681 | TN |
NPI | 1023013307 |
---|---|
Provider Name | Dr. Periclis Roussis |
First Address | Knoxville, TN 37916-1839 |
Second Address | Knoxville, TN 37916-1839 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2005 |
Last Update Date | 26/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3033722 | (05) | TN |
4061072 | BCBS (01) | TN |
C36404 | (02) |