Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | MD0000024947 | TN |
NPI | 1881773778 |
---|---|
Provider Name | Mark Allen Clymer |
First Address | Brentwood, TN 37027 |
Second Address | Brentwood, TN 37027 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BC3795486 | DEA (01) | TN |
F70161 | (02) | |
MD24947 | MEDICAL (01) | TN |