Healthcare Provider Details

I. General information

NPI: 1184158768
Provider Name (Legal Business Name): MR. DONALD RAY BOX JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DONALD RAY BOX JR. BOCP, CPOA, CFO

II. Dates (important events)

Enumeration Date: 04/20/2017
Last Update Date: 04/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6515 POPLAR AVE
MEMPHIS TN
38119-4878
US

IV. Provider business mailing address

6515 POPLAR AVE
MEMPHIS TN
38119-4878
US

V. Phone/Fax

Practice location:
  • Phone: 901-530-7458
  • Fax: 901-795-1738
Mailing address:
  • Phone: 901-530-7458
  • Fax: 901-795-1738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: