Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 47542 | MA |
Y | 207YP0228X | Pediatric Otolaryngology | MD0000044593 | TN |
N | 208000000X | Pediatrician | 47542 | MA |
NPI | 1457342644 |
---|---|
Provider Name | Dr. Roland Douglas Eavey |
First Address | Nashville, TN 37232-0001 |
Second Address | Nashville, TN 37232-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2005 |
Last Update Date | 15/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0142204 | (05) | MA |
724924 | TUFTS HEALTH PLAN (01) | MA |
A66469 | (02) | |
E05535 | BCBS MA (01) | MA |