Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 29292 | TN |
N | 111NI0900X | Internist | 29292 | TN |
Y | 207RN0300X | Nephrologist | 29292 | TN |
NPI | 1003864117 |
---|---|
Provider Name | Dr. Susan Alex |
First Address | Jackson, TN 38305-3609 |
Second Address | Jackson, TN 38305-3609 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 11/11/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
09016261 | (05) | TN |
E41220 | (02) |