Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | MD0000019559 | TN |
NPI | 1083723829 |
---|---|
Provider Name | Mr. Albert E Hensel III |
First Address | Cookeville, TN 38501 |
Second Address | Cookeville, TN 38501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 21/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B89272 | (02) | |
MD0000019559 | (05) | TN |