Provider Demographics
NPI:1578899225
Name:BINKLEY, ROGER DALE SR
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:DALE
Last Name:BINKLEY
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 STIRLINGSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-9410
Mailing Address - Country:US
Mailing Address - Phone:615-405-3164
Mailing Address - Fax:615-590-7483
Practice Address - Street 1:1109 STIRLINGSHIRE DR
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-9410
Practice Address - Country:US
Practice Address - Phone:615-405-3164
Practice Address - Fax:615-590-7483
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-29
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15715171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor