Healthcare Provider Details

I. General information

NPI: 1891806659
Provider Name (Legal Business Name): DAVID AARON USDAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 11/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6005 PARK AVE SUITE 830-B
MEMPHIS TN
38119-5202
US

IV. Provider business mailing address

6005 PARK AVE SUITE 830B
MEMPHIS TN
38119-5202
US

V. Phone/Fax

Practice location:
  • Phone: 901-685-1886
  • Fax: 901-683-7742
Mailing address:
  • Phone: 901-682-1752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD5561
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: