Provider Demographics
NPI:1124005145
Name:ALTENBERN, DOUGLAS C JR (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:C
Last Name:ALTENBERN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2801 CHARLOTTE AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-4035
Mailing Address - Country:US
Mailing Address - Phone:615-250-9200
Mailing Address - Fax:615-250-9251
Practice Address - Street 1:395 WALLACE RD
Practice Address - Street 2:STE 206B
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-4881
Practice Address - Country:US
Practice Address - Phone:615-331-8281
Practice Address - Fax:615-331-3043
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD21659208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN340013309OtherRR MEDICARE
KY64799521Medicaid
TN3060807Medicaid
TN0127086OtherBLUE CROSS
C68856Medicare UPIN