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General NPI Number Information
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NPI Number | 1548566839
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Entity Type | Organization
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Legal Business Name | MEMPHIS OBSTETRICS AND GYNECOLOGY P.C.
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Dates
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Enumeration Date | 02/03/2011
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Last Update Date | 02/03/2011
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Provider Practice Location Address
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Address Line | 6246 POPLAR AVE
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City | MEMPHIS
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State | TN
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Zip | 38119-4713
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Country | US
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Telephone | 901-761-4491
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Fax | 901-761-2359
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Provider Business Mailing Address
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Address Line | 6246 POPLAR AVE
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City | MEMPHIS
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State | TN
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Zip | 38119-4713
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Country | US
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Telephone | 901-761-4491
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Fax | 901-761-2359
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | JOSEPH C DEWANE
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Credential | MD
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Telephone | 901-761-4491
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 12115
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License Number State | TN
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