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General NPI Number Information
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NPI Number | 1578899225
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Entity Type | Individual
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Provider Name | ROGER DALE BINKLEY SR.
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Gender | Male
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Dates
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Enumeration Date | 10/29/2009
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Last Update Date | 10/29/2009
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Provider Practice Location Address
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Address Line | 1109 STIRLINGSHIRE DR
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City | HENDERSONVILLE
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State | TN
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Zip | 37075-9410
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Country | US
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Telephone | 615-405-3164
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Fax | 615-590-7483
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Provider Business Mailing Address
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Address Line | 1109 STIRLINGSHIRE DR
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City | HENDERSONVILLE
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State | TN
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Zip | 37075-9410
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Country | US
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Telephone | 615-405-3164
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Fax | 615-590-7483
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number | 15715
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License Number State | TN
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