Healthcare Provider Details

I. General information

NPI: 1730142795
Provider Name (Legal Business Name): CARDIOVASCULAR SPECIALIST , P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 UNION AVE
MEMPHIS TN
38104-6643
US

IV. Provider business mailing address

MSC 410702 P O BOX 415000
NASHVILLE TN
37241-0001
US

V. Phone/Fax

Practice location:
  • Phone: 901-722-0340
  • Fax:
Mailing address:
  • Phone: 901-722-0340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberD32091
License Number StateTN

VIII. Authorized Official

Name: MR. FRANK MARTIN
Title or Position: OWNER
Credential: MD
Phone: 901-722-0340