Provider Demographics
NPI:1104801851
Name:CONCEPCION, RAOUL S (MD)
Entity type:Individual
Prefix:
First Name:RAOUL
Middle Name:S
Last Name:CONCEPCION
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 1:28 WHITE BRIDGE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-1499
Mailing Address - Country:US
Mailing Address - Phone:615-290-0622
Mailing Address - Fax:
Practice Address - Street 1:28 WHITE BRIDGE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-1499
Practice Address - Country:US
Practice Address - Phone:615-290-0622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD17400208800000X
KY37172208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0108772OtherBLUE CROSS
TN340013316OtherRR MEDICARE
KY64797269Medicaid
TN3051346Medicaid
KY64797269Medicaid