Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 42475 | TN |
N | 204F00000X | Transplant Surgeon | A90760 | CA |
N | 208200000X | Surgeon | 42475 | TN |
N | 208600000X | Surgeon | 42475 | TN |
NPI | 1366452484 |
---|---|
Provider Name | Jason M Vanatta |
First Address | Memphis, TN 38148-0001 |
Second Address | Memphis, TN 38104-3415 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2006 |
Last Update Date | 21/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I39969 | (02) | CA |