MEDICARE: JOHN D FLEENOR 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	207R00000X	Internal Medicine Physician	31953	TN
2	207P00000X	Emergency Medicine Physician	31953	TN
3	207P00000X	Emergency Medicine Physician	019455	SC

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427098508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN D FLEENOR MD

Provider Business Mailing Address
First Line	:	9245 POPLAR AVE
Second Line	:	SUITE 8 #121
City	:	GERMANTOWN
State	:	TN
Zip	:	38138-7931
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6263 POPLAR AVE
Second Line	:	#1052
City	:	MEMPHIS
State	:	TN
Zip	:	38119-4701
Country	:	US
Telephone Number	:	901-761-6157
Fax Number	:

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

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	05/21/2008

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Directions to “ JOHN D FLEENOR MD” Practice Location

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