Provider Demographics
NPI:1679592869
Name:AGBENOHEVI, REXFORD YAO (MD)
Entity type:Individual
Prefix:DR
First Name:REXFORD
Middle Name:YAO
Last Name:AGBENOHEVI
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 1:315 N WASHINGTON AVE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-2603
Mailing Address - Country:US
Mailing Address - Phone:931-372-8668
Mailing Address - Fax:931-372-2597
Practice Address - Street 1:315 N WASHINGTON AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2603
Practice Address - Country:US
Practice Address - Phone:931-372-8668
Practice Address - Fax:931-372-2597
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34431207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4114708OtherBCBS
TN385567Medicaid
TN385567Medicaid
TN4114708OtherBCBS
TN3855768Medicare ID - Type Unspecified
TNHI9178Medicare UPIN