MEDICARE: REMY A VALDIVIA MD

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	208100000X	Physical Medicine & Rehabilitation Physician	37511	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4116255	OTHER	TN	BLUE CROSS/ BLUE SHIELD

General Provider Information

NPI Number	:	1457383952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REMY A VALDIVIA MD

Provider Business Mailing Address
First Line	:	PO BOX 419
Second Line	:
City	:	MEDINA
State	:	TN
Zip	:	38355-0419
Country	:	US
Telephone Number	:	731-668-9899
Fax Number	:	731-660-2121

Provider Business Practice Location Address
First Line	:	3363 N HIGHLAND AVE
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-3487
Country	:	US
Telephone Number	:	731-668-9899
Fax Number	:	731-660-2121

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

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

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Directions to “ REMY A VALDIVIA MD” Practice Location

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