Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 21117 | TN |
NPI | 1023045556 |
---|---|
Provider Name | Gabriel A Ojeda |
First Address | Loudon, TN 37774-2851 |
Second Address | Loudon, TN 37774-2851 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2006 |
Last Update Date | 24/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
060040858 | RR MEDICARE PIN (01) | TN |
3072909 | (05) | TN |
F48865 | (02) |