Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | 38132 | TN |
NPI | 1235125931 |
---|---|
Provider Name | Raymond J Gardocki |
First Address | Nashville, TN 37204-4701 |
Second Address | Nashville, TN 37232-2205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2005 |
Last Update Date | 03/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
09122578 | (05) | MS |
165839001 | (05) | AR |
I01200 | (02) | TN |
Q016960 | (05) | TN |