Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207KA0200X | Allergist | 4080 | TN |
N | 208000000X | Pediatrician | 231750 | TN |
NPI | 1578657334 |
---|---|
Provider Name | Dr. Timothy C. Frazier |
First Address | Knoxville, TN 37916-1111 |
Second Address | Knoxville, TN 37916-1111 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3028772 | BCBS OF TN (01) | TN |
3085235 | (05) | TN |
E39171 | (02) |