Healthcare Provider Details

I. General information

NPI: 1639326010
Provider Name (Legal Business Name): ZACHARY B SELF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2008
Last Update Date: 11/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 COVINGTON PIKE SUITE 100
MEMPHIS TN
38128-5048
US

IV. Provider business mailing address

3030 COVINGTON PIKE SUITE 100
MEMPHIS TN
38128-5048
US

V. Phone/Fax

Practice location:
  • Phone: 901-383-8889
  • Fax: 901-383-2245
Mailing address:
  • Phone: 901-383-8889
  • Fax: 901-383-2245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number46790
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number46790
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: