Healthcare Provider Details

I. General information

NPI: 1790766079
Provider Name (Legal Business Name): DAVID ESPINOLA SANMIGUEL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 12/14/2023
Certification Date: 12/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2341 MCCALLIE AVE SUITE 402
CHATTANOOGA TN
37404-3239
US

IV. Provider business mailing address

PO BOX 4087
CHATTANOOGA TN
37405-0087
US

V. Phone/Fax

Practice location:
  • Phone: 423-698-3309
  • Fax: 423-698-3309
Mailing address:
  • Phone: 423-710-5233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number84546
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberD01446
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: