Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | DS02991 | TN |
NPI | 1194704171 |
---|---|
Provider Name | Thomas C Whittaker |
First Address | Knoxville, TN 37917 |
Second Address | Knoxville, TN 37917 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3223817 | (05) | TN |
T74293 | (02) |