Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0102X | Surgical Critical Care | MD30945 | TN |
NPI | 1114058658 |
---|---|
Provider Name | John H. Selby JR. |
First Address | Nashville, TN 37232-8678 |
Second Address | Nashville, TN 37232-5100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AS9384671 | DEA (01) | |
C68208 | (02) |