Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 28710 | TN |
NPI | 1235230707 |
---|---|
Provider Name | Kenneth Hugh Mccarley |
First Address | Cleveland, TN 37311-3879 |
Second Address | Cleveland, TN 37311-3879 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 31/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1811876 | (05) | TN |
E73070 | (02) |