Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | MD21734 | TN |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | MD21734 | TN |
NPI | 1205935632 |
---|---|
Provider Name | Gregory Mencio |
First Address | Nashville, TN 37232-8774 |
Second Address | Nashville, TN 37232-5100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2006 |
Last Update Date | 15/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C65010 | (02) |