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General NPI Number Information
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NPI Number | 1639326010
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Entity Type | Individual
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Provider Name | ZACHARY B SELF M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/27/2008
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Last Update Date | 11/22/2016
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Provider Practice Location Address
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Address Line | 3030 COVINGTON PIKE SUITE 100
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City | MEMPHIS
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State | TN
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Zip | 38128-5048
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Country | US
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Telephone | 901-383-8889
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Fax | 901-383-2245
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Provider Business Mailing Address
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Address Line | 3030 COVINGTON PIKE SUITE 100
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City | MEMPHIS
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State | TN
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Zip | 38128-5048
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Country | US
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Telephone | 901-383-8889
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Fax | 901-383-2245
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 46790
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 207VX0000X
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Taxonomy Name | Obstetrics Physician
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License Number | 46790
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License Number State | TN
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