Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 35933 | TN |
N | 2080P0208X | Pediatric Infectious Diseases | 35933 | TN |
NPI | 1336123009 |
---|---|
Provider Name | Dr. Rahaman Olatunji Suara |
First Address | Bolivar, TN 38008-8323 |
Second Address | Bolivar, TN 38008-1599 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2005 |
Last Update Date | 07/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3870746 | (05) | TN |
H51849 | (02) | TN |