Healthcare Provider Details

I. General information

NPI: 1629078324
Provider Name (Legal Business Name): JAMES T LITZOW M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 10/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7460 WOLF RIVER BLVD
GERMANTOWN TN
38138-1760
US

IV. Provider business mailing address

PO BOX 1000 DEPT # 960
MEMPHIS TN
38148-0001
US

V. Phone/Fax

Practice location:
  • Phone: 901-763-0200
  • Fax: 901-260-1713
Mailing address:
  • Phone: 901-763-0200
  • Fax: 901-260-1713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number31104
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number18207
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: