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General NPI Number Information
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NPI Number | 1275567349
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Entity Type | Organization
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Legal Business Name | SAM DELK
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 09/02/2022
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Provider Practice Location Address
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Address Line | 176 S BELLEVUE BLVD SUITE 505
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City | MEMPHIS
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State | TN
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Zip | 38104-3417
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Country | US
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Telephone | 901-725-0421
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Fax | 901-278-4675
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Provider Business Mailing Address
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Address Line | PO BOX 126
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City | MEMPHIS
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State | TN
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Zip | 38101-0126
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Country | US
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Telephone | 901-757-2345
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Fax | 901-757-9065
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Authorized Official
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Title or Position | OWNER/M.D.
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Name | DR. SAM DELK
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Credential | M.D.
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Telephone | 901-725-0421
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 37329
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License Number State | TN
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