1588637615 NPI number — RODGER J ZWEMER JR. MD

Table of content: RODGER J ZWEMER JR. MD (NPI 1588637615)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588637615 NPI number — RODGER J ZWEMER JR. MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZWEMER
Provider First Name:
RODGER
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
JR.
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588637615
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
521 MEDICAL DR
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
LIVINGSTON
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38570-1879
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
931-403-6093
Provider Business Mailing Address Fax Number:
931-403-2615

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
521 MEDICAL DR
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
LIVINGSTON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38570-1879
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-403-6093
Provider Business Practice Location Address Fax Number:
931-403-2615
Provider Enumeration Date:
02/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  MD25850 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3087958 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 37164741 . This is a "MEDICARE GROUP" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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