Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 018998 | TN |
Y | 207R00000X | Internist | TN18998 | TN |
Y | 111NI0900X | Internist | TN18998 | TN |
N | 207RA0401X | Internist - Addiction Medicine | TN18998 | TN |
NPI | 1497792253 |
---|---|
Provider Name | Kenneth P Trzil |
First Address | Jonesborough, TN 37659-3443 |
Second Address | Harrogate, TN 37752 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2006 |
Last Update Date | 02/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3033542 | (05) | TN |
A99717 | (02) | TN |