Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | MD018500 | TN |
NPI | 1134162134 |
---|---|
Provider Name | Dr. Stephen J D'amico |
First Address | Brentwood, TN 37027-8833 |
Second Address | Antioch, TN 37013-2789 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 08/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3704341 | (05) | TN |
A99979 | (02) | TN |