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NPI Code Detail

MEDICARE: DR. GREGORY EUGENE VANDEVEN M.D.

MEDICARE: DR. GREGORY EUGENE VANDEVEN M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208M00000XHospitalist Physician27297TN
2207R00000XInternal Medicine Physician27297TN

General Provider Information

NPI Number : 1811969157
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GREGORY EUGENE VANDEVEN M.D.
Provider Business Mailing Address
First Line : 3960 KNIGHT ARNOLD RD
Second Line : SUITE 322
City : MEMPHIS
State : TN
Zip : 38118-3035
Country : US
Telephone Number : 901-369-4949
Fax Number : 901-369-6029
Provider Business Practice Location Address
First Line : 3000 GETWELL RD
Second Line :
City : MEMPHIS
State : TN
Zip : 38118-2205
Country : US
Telephone Number : 901-369-8100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/02/2006
Last Update Date : 07/21/2022

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