Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | MD11224 | TN |
NPI | 1013900273 |
---|---|
Provider Name | Thomas Robert Miller |
First Address | Knoxville, TN 37920-1527 |
Second Address | Knoxville, TN 37920-2453 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2005 |
Last Update Date | 24/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3153678 | BLUECROSS/BLUESHIELD (01) | TN |
3723987 | (05) | TN |
390007316 | RAILROAD MEDICARE (01) | TN |
B03179 | (02) |