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General NPI Number Information
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NPI Number | 1629022066
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Entity Type | Individual
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Provider Name | YVETTE RANDLE OSWELL MD
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Gender | Female
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Dates
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Enumeration Date | 05/20/2006
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Last Update Date | 01/07/2016
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Provider Practice Location Address
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Address Line | 5142 STAGE RD SUITE 100
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City | MEMPHIS
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State | TN
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Zip | 38134-3164
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Country | US
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Telephone | 901-382-2040
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Fax | 901-386-5242
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Provider Business Mailing Address
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Address Line | 5142 STAGE RD SUITE 100
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City | MEMPHIS
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State | TN
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Zip | 38134-3164
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Country | US
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Telephone | 901-382-2040
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Fax | 901-386-5242
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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 | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | MD0000028644
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 28644
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License Number State | TN
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