Provider Demographics
NPI:1639360142
Name:PETER M. KLARA, M.D., PC
Entity Type:Organization
Organization Name:PETER M. KLARA, M.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:K
Authorized Official - Last Name:FOGLIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-455-8484
Mailing Address - Street 1:1940 N JACKSON ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-8254
Mailing Address - Country:US
Mailing Address - Phone:931-455-8484
Mailing Address - Fax:931-455-8440
Practice Address - Street 1:1940 N JACKSON ST
Practice Address - Street 2:SUITE 150
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-8254
Practice Address - Country:US
Practice Address - Phone:931-455-8484
Practice Address - Fax:931-455-8440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN23924207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3733161Medicaid
B08027Medicare UPIN
TN3733161Medicare UPIN