Healthcare Provider Details

I. General information

NPI: 1275506404
Provider Name (Legal Business Name): REX ALLEN AMONETTE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 UNION AVE
MEMPHIS TN
38104-6727
US

IV. Provider business mailing address

1455 UNION AVE
MEMPHIS TN
38104-6727
US

V. Phone/Fax

Practice location:
  • Phone: 901-726-6655
  • Fax: 901-726-9056
Mailing address:
  • Phone: 901-726-6655
  • Fax: 901-726-9056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberMD6594
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberMD6594
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberMD6594
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: