Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | DS0000002901 | TN |
NPI | 1306837851 |
---|---|
Provider Name | Mr. Harold Clay Peeples |
First Address | Madison, TN 37115-2292 |
Second Address | Madison, TN 37115-2292 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2005 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T74259 | (02) | TN |