Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | MD16984 | TN |
N | 207KA0200X | Allergist | MD16984 | TN |
NPI | 1437289725 |
---|---|
Provider Name | Jeffrey L Schlactus |
First Address | Knoxville, TN 37919-7360 |
Second Address | Knoxville, TN 37909-2706 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2007 |
Last Update Date | 07/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10011730 | (05) | TN |
3024285 | (05) | TN |
60072 | BLUE CROSS (01) | TN |
A98879 | (02) | TN |