Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 28909 | TN |
NPI | 1013949031 |
---|---|
Provider Name | Thomas Michael Roy |
First Address | Mountain Home, TN 37614 |
Second Address | Mountain Home, TN 37614 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 29/01/2015 |