Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | MD17806 | TN |
NPI | 1184717381 |
---|---|
Provider Name | Humberto Rodriguez |
First Address | Knoxville, TN 37995-0001 |
Second Address | Knoxville, TN 37920-1502 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 14/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3025341 | (05) | TN |
A98945 | (02) | TN |