Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 7998 | TN |
N | 204E00000X | Oral & Maxillofacial Surgeon | MD38394 | TN |
NPI | 1174616171 |
---|---|
Provider Name | Eric R. Carlson |
First Address | Nashville, TN 37244-0131 |
Second Address | Knoxville, TN 37920-1585 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 26/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3227456 | (05) | TN |
I13296 | (02) | TN |