Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 21512 | TN |
NPI | 1871601286 |
---|---|
Provider Name | Timothy Allen Viser |
First Address | Cleveland, TN 37311-3879 |
Second Address | Cleveland, TN 37320-5030 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2006 |
Last Update Date | 27/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3060861 | (05) | TN |
E90450 | (02) |