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Individual
ANAS EID
Active
Individual
ANAS EID
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
64361
TN
207YS0123X
Facial Plastic Surgery Physician
64361
TN
207YS0123X
Facial Plastic Surgery Physician
PENDING
TN
207YX0007X
Plastic Surgery within the Head & Neck (Otolaryngology) Physician
64361
TN
2086S0122X
Plastic and Reconstructive Surgery Physician
T1125
IA
Other
Enumeration date
03/05/2012
Last updated
03/26/2026
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