Healthcare Provider Details

I. General information

NPI: 1669439923
Provider Name (Legal Business Name): JOHN ORLAND SCHORGE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 06/21/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 MADISON AVE
MEMPHIS TN
38103-3409
US

IV. Provider business mailing address

55 FRUIT ST YAW 9E
BOSTON MA
02114-2621
US

V. Phone/Fax

Practice location:
  • Phone: 901-515-3500
  • Fax: 901-515-3509
Mailing address:
  • Phone: 617-724-4800
  • Fax: 617-724-6898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number64958
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number14268
License Number StateNH
# 3
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number153463
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: