Healthcare Provider Details

I. General information

NPI: 1679534473
Provider Name (Legal Business Name): ANDREW DEDE LIMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 UNION AVE SUITE 800
MEMPHIS TN
38104-3513
US

IV. Provider business mailing address

1331 UNION AVE SUITE 800
MEMPHIS TN
38104-3513
US

V. Phone/Fax

Practice location:
  • Phone: 901-725-1785
  • Fax: 901-725-5264
Mailing address:
  • Phone: 901-725-1785
  • Fax: 901-725-5264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number40102
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number19095
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: