Healthcare Provider Details

I. General information

NPI: 1609043249
Provider Name (Legal Business Name): JOSEPH E FOUCHE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2008
Last Update Date: 08/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 W FOREST AVENUE
JACKSON TN
38301-3902
US

IV. Provider business mailing address

PO BOX 400
JACKSON TN
38302-0400
US

V. Phone/Fax

Practice location:
  • Phone: 731-541-9561
  • Fax: 731-541-1829
Mailing address:
  • Phone: 731-423-8697
  • Fax: 731-425-5783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberMD51527
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License NumberMD51527
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: