Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 21193 | TN |
Y | 208600000X | Surgeon | 21193 | TN |
NPI | 1023081825 |
---|---|
Provider Name | Dr. Reginald William Coopwood |
First Address | Nashville, TN 37208 |
Second Address | Nashville, TN 37208 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3061255 | (05) | TN |
C77143 | (02) | TN |