Individual
DR. JON WILLIAM TAVEAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
444 CLINCHFIELD ST STE 103, KINGSPORT, TN 37660-3859
(423) 578-1518
(423) 230-6349
Mailing address
444 CLINCHFIELD ST STE 103, KINGSPORT, TN 37660-3859
(423) 578-1518
(423) 230-6349
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
036.123122
IL
207T00000X
Neurological Surgery Physician
20A9091
CA
207T00000X
Neurological Surgery Physician
Primary
3367
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036123122
—
IL
01
—
3932056
BCBS
IL
01
—
721089
AETNA
IL
05
—
Q038189
—
TN
Enumeration date
12/12/2007
Last updated
04/21/2020
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