Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | MD32158 | TN |
NPI | 1083683668 |
---|---|
Provider Name | Marc William Cromie SR. |
First Address | Chattanooga, TN 37421-2423 |
Second Address | Chattanooga, TN 37421-2423 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2006 |
Last Update Date | 22/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3851119 | (05) | TN |
H13570 | (02) |