Provider Demographics
NPI:1245214899
Name:DAY, MARDON RANDALL (DPM)
Entity Type:Individual
Prefix:
First Name:MARDON
Middle Name:RANDALL
Last Name:DAY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 PATTERSON ST
Mailing Address - Street 2:SUITE 123
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1562
Mailing Address - Country:US
Mailing Address - Phone:615-327-2200
Mailing Address - Fax:615-327-2842
Practice Address - Street 1:2400 PATTERSON ST
Practice Address - Street 2:SUITE 123
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1562
Practice Address - Country:US
Practice Address - Phone:615-327-2200
Practice Address - Fax:615-327-2842
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM000485213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3352801Medicaid
TNU54568Medicare UPIN
TN3352801Medicaid