Healthcare Provider Details

I. General information

NPI: 1639604887
Provider Name (Legal Business Name): STEFFI THOMAS D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2017
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 UNION AVE STE 200
MEMPHIS TN
38104-6654
US

IV. Provider business mailing address

PO BOX 1000 DEPT 978
MEMPHIS TN
38148-0001
US

V. Phone/Fax

Practice location:
  • Phone: 901-525-0278
  • Fax: 901-526-9014
Mailing address:
  • Phone: 901-758-9900
  • Fax: 901-752-2335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number5194
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: