Healthcare Provider Details

I. General information

NPI: 1104801851
Provider Name (Legal Business Name): RAOUL S CONCEPCION MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 04/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 WHITE BRIDGE RD SUITE 200
NASHVILLE TN
37205-1499
US

IV. Provider business mailing address

28 WHITE BRIDGE RD SUITE 200
NASHVILLE TN
37205-1499
US

V. Phone/Fax

Practice location:
  • Phone: 615-290-0622
  • Fax:
Mailing address:
  • Phone: 615-290-0622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD17400
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number37172
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: