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General NPI Number Information
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NPI Number | 1114184298
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Entity Type | Individual
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Provider Name | KEITH ALLEN TONKIN M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/17/2008
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Last Update Date | 11/19/2009
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Provider Practice Location Address
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Address Line | 6019 WALNUT GROVE RD
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City | MEMPHIS
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State | TN
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Zip | 38120-2113
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Country | US
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Telephone | 901-747-1000
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Fax | 901-747-1001
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Provider Business Mailing Address
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Address Line | 6305 HUMPHREYS BLVD SUITE 205
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City | MEMPHIS
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State | TN
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Zip | 38120-2377
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Country | US
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Telephone | 901-747-1000
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Fax | 901-747-1001
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | A103522
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License Number State | CA
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