Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | DPM000238 | TN |
NPI | 1548304405 |
---|---|
Provider Name | Dr. Richard S. Eby |
First Address | Chattanooga, TN 37412-1247 |
Second Address | Chattanooga, TN 37412-1247 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2007 |
Last Update Date | 06/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3351059 | (05) | TN |
6364350002 | PTAN (01) | TN |
T61085 | (02) | TN |