Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | DC0000001305 | TN |
NPI | 1265580559 |
---|---|
Provider Name | Dr. Troy D. Buckridge |
First Address | Seymour, TN 37865-5181 |
Second Address | Seymour, TN 37865-5181 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2007 |
Last Update Date | 02/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U70512 | (02) |