Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 63563 | TN |
N | 207R00000X | Internist | 2017-01023 | NC |
N | 111NI0900X | Internist | 2017-01023 | NC |
N | 208000000X | Pediatrician | 2017-01023 | NC |
N | 2080P0201X | Pediatric Allergist | 2017-01023 | NC |
N | 2080P0201X | Pediatric Allergist | 63563 | TN |
NPI | 1154764876 |
---|---|
Provider Name | Edward Gerard Abano Iglesia |
First Address | Nashville, TN 37204-4701 |
Second Address | Nashville, TN 37232-6014 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2013 |
Last Update Date | 16/10/2021 |