Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 35885 | TN |
NPI | 1760462261 |
---|---|
Provider Name | Wendell Moses |
First Address | Chattanooga, TN 37403-2101 |
Second Address | Chattanooga, TN 37403-2101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2006 |
Last Update Date | 31/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A51888 | (02) |