Individual
DR. DAVID ISONGUYO UDOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
ONE MEDICAL CENTER BLVD., SUITE 103, COOKEVILLE, TN 38501
(931) 783-2770
(931) 525-1176
Mailing address
127 N. OAK AVENUE, SUITE D, COOKEVILLE, TN 38501
(931) 783-5857
(931) 526-6760
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD28832
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1512299
—
TN
05
—
3838486
—
TN
01
—
4107089
TNCARE ID NO.
TN
Enumeration date
12/26/2006
Last updated
12/17/2009
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