Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208G00000X | Cardiothoracic Vascular Surgeon | 2010-01100 | NC |
N | 208G00000X | Cardiothoracic Vascular Surgeon | 42073 | KY |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 52593 | TN |
NPI | 1154418150 |
---|---|
Provider Name | Wilson Monroe Clements |
First Address | Chattanooga, TN 37404-1127 |
Second Address | Chattanooga, TN 37404-2600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2006 |
Last Update Date | 02/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1589G | BCBSNC (01) | NC |
5915281 | (05) | NC |
7100070870 | (05) | KY |