Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | DC191 | TN |
Y | 213ER0200X | Radiology | DC191 | TN |
NPI | 1013963461 |
---|---|
Provider Name | Dr. Robert Bruce Fox |
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 | 26/05/2006 |
Last Update Date | 28/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3675724 | (05) | TN |
T74810 | (02) | TN |