Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 632449 | TN |
Y | 207PE0004X | Emergency Medical Services | MD025183 | TN |
NPI | 1154373892 |
---|---|
Provider Name | Dr. Randall M. Minor |
First Address | Bells, TN 38006-1149 |
Second Address | Paris, TN 38242-4544 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2006 |
Last Update Date | 03/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3097925 | (05) | TN |
3119997 | BCBS (01) | TN |
G27135 | (02) | TN |