Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 20227 | TN |
NPI | 1013916295 |
---|---|
Provider Name | Mark W Alley |
First Address | Atlanta, GA 30353-5510 |
Second Address | Kingsport, TN 37660-3847 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2005 |
Last Update Date | 07/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00013859 | NHC CARE ADMIN. (01) | |
005749221 | (05) | VA |
064423 | ANTHEM BCBS (01) | |
100011088 | (05) | TN |
3037574 | BS OF TN (01) | |
3061778 | (05) | TN |
5900346 | (05) | NC |
E92301 | (02) | |
TN0100 | JOHN DEERE (01) |