Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | M0007158 | TN |
NPI | 1063416899 |
---|---|
Provider Name | Dr. Robert Carver Bone |
First Address | Lebanon, TN 37087-1512 |
Second Address | Lebanon, TN 37087-1512 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10807487 | CAQH (01) | TN |
3723409 | (05) | TN |
A98749 | (02) | TN |
AB6659974 | DEA (01) | TN |