Provider Demographics
NPI:1366594301
Name:ESPELETA, FERDINAND S (MD)
Entity type:Individual
Prefix:DR
First Name:FERDINAND
Middle Name:S
Last Name:ESPELETA
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 979
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37077-0979
Mailing Address - Country:US
Mailing Address - Phone:615-575-1080
Mailing Address - Fax:615-575-1084
Practice Address - Street 1:1525 HUNT CLUB BLVD
Practice Address - Street 2:SUITE 600-A
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-6070
Practice Address - Country:US
Practice Address - Phone:615-575-1080
Practice Address - Fax:615-575-1084
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD00000340952080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1510219Medicaid
TN1510219Medicaid