Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 31386 | NE |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | MD-45407 | IA |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | MD0000063618 | TN |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | ME149074 | FL |
NPI | 1033485404 |
---|---|
Provider Name | Ruslan Safarov |
First Address | Morristown, TN 37813-2282 |
Second Address | Morristown, TN 37813-2282 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2012 |
Last Update Date | 14/01/2022 |