Healthcare Provider Details

I. General information

NPI: 1942256102
Provider Name (Legal Business Name): RUSSELL D. BEIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2829 LAMAR AVE.
MEMPHIS TN
38114-5016
US

IV. Provider business mailing address

2829 LAMAR AVE
MEMPHIS TN
38114-5016
US

V. Phone/Fax

Practice location:
  • Phone: 901-345-6700
  • Fax: 901-345-6755
Mailing address:
  • Phone: 901-345-6700
  • Fax: 901-345-6755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD15534
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberMD15534
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD15534
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: