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NPI Code Detail

MEDICARE: SPENCER TYLER FOGELMAN DO

MEDICARE: SPENCER TYLER FOGELMAN DO
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
1207L00000XAnesthesiology Physician4677TN

General Provider Information

NPI Number : 1407352347
Entity Type Code : Individual
Provider Name (Legal Business Name) : SPENCER TYLER FOGELMAN DO
Provider Business Mailing Address
First Line : 5545 MURRAY AVE STE 130
Second Line :
City : MEMPHIS
State : TN
Zip : 38119-3861
Country : US
Telephone Number : 901-682-6828
Fax Number : 901-682-9316
Provider Business Practice Location Address
First Line : 5545 MURRAY AVE STE 130
Second Line :
City : MEMPHIS
State : TN
Zip : 38119-3861
Country : US
Telephone Number : 901-682-6828
Fax Number : 901-682-9316
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/31/2018
Last Update Date : 08/24/2022

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Directions to “ SPENCER TYLER FOGELMAN DO” Practice Location

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