Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 10634 | TN |
NPI | 1013079391 |
---|---|
Provider Name | Raymond Leroy Meneely |
First Address | Franklin, TN 37064 |
Second Address | Franklin, TN 37064 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B04162 | (02) |