Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 21719 | TN |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 21719 | TN |
NPI | 1285627398 |
---|---|
Provider Name | Stephen A Fahrig |
First Address | Nashville, TN 37228-1317 |
Second Address | Nashville, TN 37205-2013 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2005 |
Last Update Date | 16/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
38255341 | (05) | TN |
6012050 | BCBS (01) | TN |
E95405 | (02) | |
P01368029 | RR MEDICARE (01) | TN |