Basic Information
| Provider Information | |||||||||
| NPI: | 1275553703 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MURFREESBORO DERMATOLOGY CLINIC, PLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1725 MEDICAL CENTER PKWY | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | MURFREESBORO | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371292246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158934100 | ||||||||
| FaxNumber: | 6158939713 | ||||||||
| Practice Location | |||||||||
| Address1: | 1725 MEDICAL CENTER PKWY | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | MURFREESBORO | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371292246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158934100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2006 | ||||||||
| LastUpdateDate: | 04/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | NYLEN | ||||||||
| AuthorizedOfficialFirstName: | CAROLINE | ||||||||
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| AuthorizedOfficialTitleorPosition: | SUPERVISOR | ||||||||
| AuthorizedOfficialTelephone: | 6158494115 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | MD0000027511 | TN | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.