Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 43306 | TN |
NPI | 1023205531 |
---|---|
Provider Name | Gregg Christian Shepard |
First Address | Nashville, TN 37244-0100 |
Second Address | Nashville, TN 37205-2005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2007 |
Last Update Date | 10/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1506095 | (05) | TN |
4180997 | BCBS OF TN (01) | TN |