Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 01036863A | IN |
NPI | 1598882383 |
---|---|
Provider Name | Thomas L Sevier |
First Address | Muncie, IN 47305-1646 |
Second Address | Muncie, IN 47305-1646 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2007 |
Last Update Date | 08/07/2007 |