Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207T00000X | Neurosurgeon | 13408 | MS |
Y | 207T00000X | Neurosurgeon | 26316 | TN |
NPI | 1013930296 |
---|---|
Provider Name | John David Brophy |
First Address | Memphis, TN 38120-2300 |
Second Address | Memphis, TN 38120-2300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 26/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
05486344 | (05) | MS |
3012636 | BLUE CROSS BLUE SHIELD TN (01) | TN |
F99553 | (02) | |
Q007228 | (05) | TN |