Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 9533 | TN |
NPI | 1326031071 |
---|---|
Provider Name | John F Jernigan |
First Address | Oak Ridge, TN 37830-6957 |
Second Address | Oak Ridge, TN 37830-6957 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3171072 | (05) | TN |
64744444 | (05) | TN |
B03444 | (02) | TN |