Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 39766 | TN |
NPI | 1295751634 |
---|---|
Provider Name | Ms. Tracy A Pesut |
First Address | Knoxville, TN 37930-2569 |
Second Address | Knoxville, TN 37923-4205 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2006 |
Last Update Date | 06/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3332469 | (05) | TN |
I14446 | (02) |