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NPI Code Detail

MEDICARE: AMY ELISE FUNDERBURK MOCK M.D.

MEDICARE: AMY ELISE FUNDERBURK MOCK M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine PhysicianMD31772TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1114919370
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY ELISE FUNDERBURK MOCK M.D.
Provider Business Mailing Address
First Line : PO BOX 770390
Second Line :
City : MEMPHIS
State : TN
Zip : 38177-0390
Country : US
Telephone Number : 901-844-1431
Fax Number :
Provider Business Practice Location Address
First Line : 4100 AUSTIN PEAY HWY
Second Line :
City : MEMPHIS
State : TN
Zip : 38128-2502
Country : US
Telephone Number : 901-844-1431
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2005
Last Update Date : 11/30/2023

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