Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | RI5775 | RI |
Y | 208600000X | Surgeon | RI5775 | RI |
N | 2086S0129X | Vascular Surgeon | RI5775 | RI |
NPI | 1144391657 |
---|---|
Provider Name | Wahid John Abadier |
First Address | Lenoir City, TN 37772-5676 |
Second Address | Lenoir City, TN 37772-5676 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2006 |
Last Update Date | 25/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9004705 | (05) | RI |
D87293 | (02) | RI |