Healthcare Provider Details

I. General information

NPI: 1588083927
Provider Name (Legal Business Name): RICHARD GILMORE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2014
Last Update Date: 05/07/2021
Certification Date: 05/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7945 WOLF RIVER BLVD
MEMPHIS TN
38138-1762
US

IV. Provider business mailing address

7945 WOLF RIVER BLVD
GERMANTOWN TN
38138-1762
US

V. Phone/Fax

Practice location:
  • Phone: 901-683-0055
  • Fax:
Mailing address:
  • Phone: 901-683-0055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number61084
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: