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General NPI Number Information
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NPI Number | 1699947713
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Entity Type | Organization
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Legal Business Name | POPLAR PRIMARY CARE PC
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Dates
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Enumeration Date | 03/28/2008
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Last Update Date | 06/24/2008
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Provider Practice Location Address
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Address Line | 3445 POPLAR AVE SUITE100
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City | MEMPHIS
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State | TN
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Zip | 38111-4667
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Country | US
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Telephone | 901-323-7651
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Fax |
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Provider Business Mailing Address
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Address Line | 3445 POPLAR AVE SUITE100
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City | MEMPHIS
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State | TN
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Zip | 38111-4667
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Country | US
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Telephone | 901-323-7651
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GUMERSINDO LEAL
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Credential | MD
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Telephone | 901-323-7651
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | 26031
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License Number State | TN
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