Healthcare Provider Details

I. General information

NPI: 1184640336
Provider Name (Legal Business Name): BANCROFT OQUINN JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 WEST BADDOUR PARKWAY SUITE 106
LEBANON TN
37087
US

IV. Provider business mailing address

1405 BADDOUR PARKWAY SUITE 106
LEBANON TN
37087
US

V. Phone/Fax

Practice location:
  • Phone: 615-444-6500
  • Fax: 615-449-1306
Mailing address:
  • Phone: 615-444-6500
  • Fax: 615-449-1306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number18417
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD0000018417
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: