Provider Demographics
NPI:1457383952
Name:VALDIVIA, REMY A (MD)
Entity Type:Individual
Prefix:
First Name:REMY
Middle Name:A
Last Name:VALDIVIA
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:PO BOX 419
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:TN
Mailing Address - Zip Code:38355-0419
Mailing Address - Country:US
Mailing Address - Phone:731-668-9899
Mailing Address - Fax:731-660-2121
Practice Address - Street 1:3363 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3487
Practice Address - Country:US
Practice Address - Phone:731-668-9899
Practice Address - Fax:731-660-2121
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37511208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4116255OtherBLUE CROSS/ BLUE SHIELD
TN3886944Medicare ID - Type Unspecified
TN4116255OtherBLUE CROSS/ BLUE SHIELD