Provider Demographics
NPI:1902881626
Name:TROOP, JOE R JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOE
Middle Name:R
Last Name:TROOP
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1514 SPARTA ST
Mailing Address - Street 2:
Mailing Address - City:MC MINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37110-1317
Mailing Address - Country:US
Mailing Address - Phone:931-473-8400
Mailing Address - Fax:931-473-0620
Practice Address - Street 1:1514 SPARTA ST
Practice Address - Street 2:
Practice Address - City:MC MINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-1317
Practice Address - Country:US
Practice Address - Phone:931-473-8400
Practice Address - Fax:931-473-0620
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD5667207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
08014732OtherRAILROAD MEDICARE
TN3719411OtherMEDICARE
TN4121909OtherBLUE CROSS BLUE SHIELD
TN3149746Medicare PIN
TNBO2259Medicare UPIN