Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | MD17817 | TN |
NPI | 1023029469 |
---|---|
Provider Name | Mr. Bruce Corwyn Raffel |
First Address | Crossville, TN 38555-1903 |
Second Address | Crossville, TN 38555-1903 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2006 |
Last Update Date | 08/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3029560 | (05) | TN |
4081698 | BLUE CROSS (01) | TN |
A99349 | (02) | |
P00157378 | RAILROAD MEDICARE (01) |