Healthcare Provider Details

I. General information

NPI: 1588858567
Provider Name (Legal Business Name): EDMUNDO H YIBIRIN PELUFFO M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2007
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 WOLVERINE TRAIL SUITE 202
SMYRNA TN
37167
US

IV. Provider business mailing address

301 WOLVERINE TRL STE 202
SMYRNA TN
37167-5656
US

V. Phone/Fax

Practice location:
  • Phone: 615-801-2087
  • Fax: 615-462-7062
Mailing address:
  • Phone: 615-801-2087
  • Fax: 615-462-7062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberMD43802
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD43802
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: