Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 30775 | TN |
Y | 207RI0011X | Interventional Cardiology | MD30775 | TN |
NPI | 1043326176 |
---|---|
Provider Name | Stacy David Brewington |
First Address | Cookeville, TN 38501 |
Second Address | Cookeville, TN 38501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2006 |
Last Update Date | 15/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3836719 | (05) | TN |
4288870 | BCBS (01) | TN |
7100015180 | (05) | KY |
G97776 | (02) |