Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD017935 | TN |
NPI | 1003013160 |
---|---|
Provider Name | Dr. William P. Grabenstein |
First Address | Clarksville, TN 37043-4605 |
Second Address | Clarksville, TN 37043-4605 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2007 |
Last Update Date | 29/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3728817 | (05) | TN |
3728817 | MEDICARE PTAN (01) | TN |
4102307 | BLUE CROSS BLUE SHIELD (01) | TN |
A99546 | (02) | TN |