Provider Demographics
NPI:1710091657
Name:ARRADONDO, JOHN E (MD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:E
Last Name:ARRADONDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 STATE STREET
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203
Mailing Address - Country:US
Mailing Address - Phone:615-329-4357
Mailing Address - Fax:615-342-0015
Practice Address - Street 1:1811 STATE STREET
Practice Address - Street 2:PRIMARY CARE AND PAIN RELIEF CENTER
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203
Practice Address - Country:US
Practice Address - Phone:615-329-4357
Practice Address - Fax:615-342-0015
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2010-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD8673207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN11118894Medicaid
TN11118894Medicaid
TN3828167Medicare ID - Type Unspecified