Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | MD.017835 | LA |
Y | 207Q00000X | Family Doctor | MD46742 | TN |
N | 207QS0010X | Family Doctor - Sports Medicine | MD.017835 | LA |
N | 207QS0010X | Family Doctor - Sports Medicine | MD46742 | TN |
NPI | 1013095603 |
---|---|
Provider Name | Dr. Thomas Michael John |
First Address | Brentwood, TN 37027-4561 |
Second Address | Brentwood, TN 37027-4561 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 05/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1522028 | (05) | TN |
2774721-00 | (05) | FL |
46742 | TN LIC NUMBER (01) | TN |
93413 | BCBSFL (01) | FL |
AJ2865105 | DEA NUMBER (01) | LA |
B64794 | (02) | LA |
MD.017835 | LOUISIANA MEDICAL LICENSE (01) | LA |
ME97701 | FLORIDA MED LICENSE (01) | FL |