Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | DPM264 | TN |
Y | 222Z00000X | Podiatrist | DPM264 | TN |
NPI | 1013912393 |
---|---|
Provider Name | Gerald B Calia |
First Address | Oak Ridge, TN 37830-6926 |
Second Address | Oak Ridge, TN 37830-6926 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2005 |
Last Update Date | 28/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3351215 | (05) | TN |
38741 | BLUE CROSS (01) | TN |
U25604 | (02) | TN |