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Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
CSFA

Contact information

Practice address
3441 DICKERSON PIKE, NASHVILLE, TN 37207-2539
(615) 342-1000
Mailing address
3441 DICKERSON PIKE, NASHVILLE, TN 37207-2539

Taxonomy

Speciality
Code
Description
License number
State
207XX0801X
Orthopaedic Trauma Physician
95214
CO
208600000X
Surgery Physician
95214
CO
374700000X
Technician
Primary

Other

Enumeration date
04/15/2019
Last updated
04/15/2019
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