Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | MD52312 | TN |
NPI | 1023077534 |
---|---|
Provider Name | Dr. Ratheany Sakbun |
First Address | Powell, TN 37849-3568 |
Second Address | Powell, TN 37849-3568 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2006 |
Last Update Date | 31/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G65343 | (02) | |
Q012154 | (05) | TN |