Healthcare Provider Details

I. General information

NPI: 1861482259
Provider Name (Legal Business Name): ROGER N PASSMORE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 03/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5651 FRIST BLVD SUITE 200
HERMITAGE TN
37076-2054
US

IV. Provider business mailing address

3024 BUSINESS PARK CIR
GOODLETTSVILLE TN
37072-3132
US

V. Phone/Fax

Practice location:
  • Phone: 615-885-0200
  • Fax: 615-885-0267
Mailing address:
  • Phone: 615-855-6033
  • Fax: 615-296-9939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number32048
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number32048
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: