MEDICARE: DR. TOLAN VU MD

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
1	207Q00000X	Family Medicine Physician	16087	TN

Other Identifiers

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

General Provider Information

NPI Number	:	1205820123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TOLAN VU MD

Provider Business Mailing Address
First Line	:	877 JEFFERSON AVE
Second Line	:	5TH FLOOR ADAMS PAVILION
City	:	MEMPHIS
State	:	TN
Zip	:	38103-2807
Country	:	US
Telephone Number	:	901-515-5300
Fax Number	:	901-358-6908

Provider Business Practice Location Address
First Line	:	2574 FRAYSER BLVD
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38127-5829
Country	:	US
Telephone Number	:	901-515-5300
Fax Number	:	901-358-6908

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2005
Last Update Date	:	12/31/2009

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