Provider Demographics
NPI:1821048521
Name:OJEDA, NESTOR ARMANDO (MD)
Entity Type:Individual
Prefix:DR
First Name:NESTOR
Middle Name:ARMANDO
Last Name:OJEDA
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 1:300 S CLYDETON RD
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:TN
Mailing Address - Zip Code:37185-2140
Mailing Address - Country:US
Mailing Address - Phone:931-296-2737
Mailing Address - Fax:931-296-1656
Practice Address - Street 1:300 S CLYDETON RD
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:TN
Practice Address - Zip Code:37185-2140
Practice Address - Country:US
Practice Address - Phone:931-296-2737
Practice Address - Fax:931-296-1656
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD021076208000000X, 2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN111969OtherBC/BS
TN3056699Medicaid
TN111969OtherBC/BS