Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | 2957 | WV |
NPI | 1225086747 |
---|---|
Provider Name | Gordon Niel Holen |
First Address | Sevierville, TN 37862-5014 |
Second Address | Sevierville, TN 37862-5014 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 13/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1529874 | (05) | TN |