Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 13711 | SC |
NPI | 1003844630 |
---|---|
Provider Name | Mark D Naquin |
First Address | Chattanooga, TN 37422-4686 |
Second Address | Greenville, SC 29601-3955 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2006 |
Last Update Date | 01/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
137113 | (05) | SC |
B89249 | (02) |