Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | MD29912 | TN |
N | 207PP0204X | Pediatric Emergency Physician | MD29912 | TN |
Y | 208000000X | Pediatrician | MD29912 | TN |
NPI | 1326102930 |
---|---|
Provider Name | Dr. Steven T Riley |
First Address | Gallatin, TN 37066-2523 |
Second Address | Gallatin, TN 37066-2523 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2006 |
Last Update Date | 22/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BR5714250 | DEA (01) | TN |
G90874 | (02) | TN |