MEDICARE: DR. WAYNE J RILEY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	K0172	TX

General Provider Information

NPI Number	:	1386680676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WAYNE J RILEY M.D.

Provider Business Mailing Address
First Line	:	1005 DR. D. B. TODD BLVD
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37208-3599
Country	:	US
Telephone Number	:	615-327-6759
Fax Number	:	615-327-6540

Provider Business Practice Location Address
First Line	:	1005 DR. D. B. TODD BLVD
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37208-3599
Country	:	US
Telephone Number	:	615-327-6759
Fax Number	:	615-327-6540

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	07/08/2007

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