Individual
MILTON O MEDEIROS
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3035 N HIGHLAND AVE, JACKSON, TN 38305-3411
(731) 664-0899
(731) 664-0946
Mailing address
3035 N HIGHLAND AVE, JACKSON, TN 38305-3411
(731) 664-0899
(731) 664-0946
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
7727
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000034150
TLC NO
TN
01
—
000000165679
UNISON NO
TN
05
—
3827978
—
TN
01
—
4105401
BCBS OF TENNESSEE
TN
01
—
P00242733
RAILROAD MEDICARE NO
TN
Enumeration date
03/14/2006
Last updated
07/09/2007
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