Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 6961 | TN |
NPI | 1346203783 |
---|---|
Provider Name | Dr. Richard Donaldson |
First Address | Hixson, TN 37343-4093 |
Second Address | Hixson, TN 37343-4093 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2006 |
Last Update Date | 03/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3173936 | (05) | TN |
4049435 | BLUE CROSS BLUE SHIELD (01) | TN |
BO3633 | (02) | TN |