Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | DC196 | TN |
NPI | 1366496275 |
---|---|
Provider Name | Dr. Richard L. Cole |
First Address | Bartlett, TN 38134-3812 |
Second Address | Bartlett, TN 38134-3812 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2006 |
Last Update Date | 06/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
23032 | BCBS ID (01) | TN |
T74810 | (02) | TN |