Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | MD43521 | TN |
NPI | 1306969696 |
---|---|
Provider Name | Dr. Raul Couret JR. |
First Address | Hendersonville, TN 37075-2481 |
Second Address | Hendersonville, TN 37075-2481 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2007 |
Last Update Date | 10/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
103I081900 | (02) | TN |
3001820 | (05) | TN |