Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | MD7369 | TN |
Y | 208600000X | Surgeon | MD7369 | TN |
NPI | 1013973874 |
---|---|
Provider Name | Mr. Reynaldo A Olaechea |
First Address | Crossville, TN 38555-5048 |
Second Address | Crossville, TN 38555 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2006 |
Last Update Date | 19/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
020038845 | MEDICARE RAILROAD (01) | |
31535161 | (05) | TN |
B59243 | (02) |