Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 16194 | TN |
NPI | 1013095264 |
---|---|
Provider Name | Stephen J Obermeier |
First Address | Madison, TN 37116-0488 |
Second Address | Madison, TN 37115-2202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3013029 | (05) | TN |
A97702 | (02) |