Healthcare Provider Details

I. General information

NPI: 1285645275
Provider Name (Legal Business Name): THE ENDOCRINE CLINIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 04/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5659 S REX RD
MEMPHIS TN
38119-3821
US

IV. Provider business mailing address

5659 S REX RD
MEMPHIS TN
38119-3821
US

V. Phone/Fax

Practice location:
  • Phone: 901-763-3636
  • Fax: 901-255-3636
Mailing address:
  • Phone: 901-763-3636
  • Fax: 901-255-3636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. ALAN JAY COHEN
Title or Position: PRESIDENT/MEDICAL DIRECTOR
Credential: M.D.
Phone: 901-763-3636