Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | MD0000026655 | TN |
NPI | 1033180948 |
---|---|
Provider Name | Keith Douglas Nord |
First Address | Jackson, TN 38305-3931 |
Second Address | Jackson, TN 38305-3830 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2006 |
Last Update Date | 24/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3091423 | (05) | TN |
F25524 | (02) | TN |