Healthcare Provider Details

I. General information

NPI: 1679773832
Provider Name (Legal Business Name): ROY C. PAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 07/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3960 KNIGHT ARNOLD RD #322
MEMPHIS TN
38118-3035
US

IV. Provider business mailing address

3960 KNIGHT ARNOLD RD #322
MEMPHIS TN
38118-3035
US

V. Phone/Fax

Practice location:
  • Phone: 901-369-4949
  • Fax: 901-369-6029
Mailing address:
  • Phone: 901-369-4949
  • Fax: 901-369-6029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number002608
License Number StateTN

VIII. Authorized Official

Name: DR. ROY C PAGE
Title or Position: OWNER
Credential: MD
Phone: 901-369-4949