Healthcare Provider Details

I. General information

NPI: 1104812478
Provider Name (Legal Business Name): JOHN COLEMAN WESTERKAMM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 01/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 NORTHCREST DR
SPRINGFIELD TN
37172-3973
US

IV. Provider business mailing address

451 NORTHCREST DR
SPRINGFIELD TN
37172-3973
US

V. Phone/Fax

Practice location:
  • Phone: 615-433-7302
  • Fax: 615-433-7303
Mailing address:
  • Phone: 615-433-7302
  • Fax: 615-433-7303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number44369
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: