Healthcare Provider Details

I. General information

NPI: 1255607164
Provider Name (Legal Business Name): DMITRY M YARANOV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2012
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6027 WALNUT GROVE RD STE 112
MEMPHIS TN
38120-2115
US

IV. Provider business mailing address

8060 WOLF RIVER BLVD
GERMANTOWN TN
38138-1727
US

V. Phone/Fax

Practice location:
  • Phone: 901-271-1000
  • Fax: 901-271-4187
Mailing address:
  • Phone: 901-271-1000
  • Fax: 901-271-4187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberE-13438
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number59402
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License Number59402
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: