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Physicians Dermatology

Provider NPI: 1649493123

Provider Information:
Gender: M
Sole Proprietor

Practice Location:
930 MADISON AVE STE 801  MEMPHIS, TN 38103-3410 US
Tel: 901-866-8805  Fax: --

Business Mailing Address:
1407 UNION AVE STE 700  MEMPHIS, TN 38104-3641 US
Tel: --  Fax: --

NPI Information:
NPI: 1649493123
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 207ND0900X





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